Professional boundary blurring and role dilution: a taxonomy of diabetes educator activities in Malaysian primary care.

backgroundThis study develops a comprehensive taxonomy of Diabetes Educators' (DEs) activities in Malaysian primary health clinics (PHCs) to analyze the "blurring" of professional boundaries between specialized education and general clinical duties.

methodsA sequential mixed-methods design was used. Phase 1 defined role expectations through document analysis and expert interviews. Phase 2 validated activities through five-day direct observations of 51 DEs across 43 clinics. Each trained observer monitored the same DE for five consecutive working days. All DE activities, including clinical duties, administrative tasks, and other related activities (discussions, meetings, community outreach), were recorded. Findings were based on frequency rather than time-weighted workload.

resultsThe taxonomy identified 146 activities across five domains. While 56.85% were patient-centric, results revealed significant role dilution, with 32.19% of activities dedicated to non-diabetes care. Activities were further classified into core specialized, routine clinical, and clerical/delegable categories, revealing significant systemic task-shifting. 'Clerical/delegable' (39.04%) highlighted a heavy clerical burden. This research captured the empirical operational reality of DEs, providing evidence of systemic task-shifting in high-volume settings.

conclusionsThe taxonomy clarifies the role of DEs by delineating "core specialized" from "clerical/delegable" tasks. This framework provides an essential evidence-based tool for Family Medicine Specialists to optimize the distribution of human resources, mitigate role dilution, and improve the quality of care in high-volume PHC settings.