Barriers and facilitators to using patient-reported experience measures for diabetes care: a qualitative study in Thailand

Background: Patient-reported experience measures (PREMs) provide valuable insights into care quality from the patient's perspective and are particularly relevant for chronic conditions such as type 2 diabetes mellitus (T2DM). However, evidence on their implementation in primary care settings of low- and middle-income countries (LMIC) remains limited. Objective: This study explored barriers and facilitators to implementing a diabetes-specific PREM in routine outpatient care in a district-level hospital setting in northern Thailand, to inform strategies for its feasible and sustainable use in similar resource-constrained settings. Methods: A qualitative study was conducted using in-depth interviews and a group interview with patients aged 20 years and older living with T2DM, healthcare providers, and the hospital executive team. A total of 25 participants were purposively selected from a hospital-based non-communicable disease (NCD) clinic. Data were collected using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR) and analysed using inductive thematic analysis. Patient demographic data were analysed descriptively. Results: Among the 19 patients included, the mean age was 59.7 years (SD = 11.9), with a range of educational and occupational backgrounds. Thematic analysis revealed three overarching themes influencing PREM implementation: patient-related factors, instrument characteristics, and contextual and implementation factors. Key facilitators included patients' perceived value of the PREM, trust in healthcare providers, and supportive organizational structures that enable workflow integration and staff allocation. Major barriers were limited literacy, functional constraints among older adults, and challenges related to instrument wording, format preferences, and insufficient resources for staff assistance. Conclusion: Addressing these factors through tailored questionnaires, flexible administration, and institutional commitment can support the routine collection of patient-reported experiences, strengthen patient-centred care, and inform implementation strategies in similar primary care settings across Southeast Asia.