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Rondeaux S, Braeckman T, Beckwé M, El Oueriaghli El Ghammaz D, Devroey D, De Vriese C. Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2819. [PMID: 36833517 PMCID: PMC9956138 DOI: 10.3390/ijerph20042819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
There is an increasing motivation to implement pharmacist-led screening services in community pharmacies. This study aims to develop tools to support the pharmacist in the context of a diabetes and cardiovascular disease risk assessment service. Our development involved a multistep process using a user-centred approach, including a need assessment phase (14 patients, 17 pharmacists) and a creative design phase, followed by the evaluation of the materials (10 patients, 16 pharmacists). Three following themes covering educational needs emerged from stakeholders' discussions: "content", "layout", and "form", with three additional themes regarding the practical organisation: "software", "awareness", and "referral". Based on the need assessment, tools for patient education purposes and awareness campaigns were created. During the development, special attention was paid to the writing style and structure with less text and more graphical colourful elements to suit patients with different health literacy and educational levels. The evaluation phase allowed researchers to observe participants engaging with the materials. Overall, participants were satisfied with the tools. The contents were considered valuable and relevant. However, adaptations were necessary to ensure their understanding and long-term usability. Finally, future research is required to evaluate the materials' impact on patients' behaviour towards their identified risk factors and ensure their effectiveness.
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Affiliation(s)
- Sarah Rondeaux
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Tessa Braeckman
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium
| | - Mieke Beckwé
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium
| | - Dounia El Oueriaghli El Ghammaz
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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Changsieng P, Pichayapinyo P, Lagampan S, Lapvongwatana P. Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial. J Prim Care Community Health 2023; 14:21501319231181106. [PMID: 37335030 DOI: 10.1177/21501319231181106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control. AIM To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels. METHODS We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test. RESULTS One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater. CONCLUSION The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.
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Affiliation(s)
- Piyanat Changsieng
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Panan Pichayapinyo
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Sunee Lagampan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Punyarat Lapvongwatana
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
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Tamiru S, Dugassa M, Amsalu B, Bidira K, Bacha L, Tsegaye D. Effects of Nurse-Led diabetes Self-Management education on Self-Care knowledge and Self-Care behavior among adult patients with type 2 diabetes mellitus attending diabetes follow up clinic: A Quasi-Experimental study design. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Widayanti AW, Heydon S, Green JA, Norris P. Effectiveness of an intensive community-based intervention for people with type 2 diabetes in Indonesia: A pilot study. Diabetes Res Clin Pract 2021; 181:109087. [PMID: 34637848 DOI: 10.1016/j.diabres.2021.109087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
AIMS This pilot study aimed to assess the acceptability of an intensive community-based intervention, and to get a preliminary estimate of the effect size of the intervention for people with type 2 diabetes in Kupang, Indonesia. METHODS Pilot of a cluster randomised trial involving sixty-seven participants. The participants were recruited from four Primary Health Centres (PHCs), and were allocated into groups (intervention: 36; control: 31) based on the PHCs they were registered in. The 3-month intervention consisted of weekly group activities including physical activity and education. Control was usual care. The outcomes were change in HbA1c, medication adherence, and self-management behaviours. To test our intervention, we used a mixed linear model, with participants nested within cluster/health centre. RESULTS Participants were 60% female, mean age 57, and had diabetes for an average of 4.5 years. Groups did not differ at baseline. Counter to prediction, no effects of the intervention over usual care were observed on the outcomes measured. However, both groups made statistically significant improvements in HbA1c (intervention from 8.3% ± 1.9 to 7.8% ± 1.8; control from 8.4% ± 2.6 to 7.9% ± 2.5). CONCLUSIONS The effect of the intervention did not differ from usual care. However, both groups made improvements in HbA1c outcome, suggesting that the project might have indirectly triggered more intensive care for diabetes patients.
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Affiliation(s)
- Anna Wahyuni Widayanti
- School of Pharmacy, University of Otago, Dunedin, New Zealand; Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand; School of Allied Health and Physical Activity for Health, Health Research Institute (HRI), University of Limerick, Limerick, Ireland.
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Chopera P, Mbambo SG, Matsungo TM. Relationships of depression and anxiety to readmission rates among patients with diabetes from Harare and Parirenyatwa referral hospitals in Zimbabwe. Afr Health Sci 2021; 21:1291-1300. [PMID: 35222594 PMCID: PMC8843272 DOI: 10.4314/ahs.v21i3.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The knowledge of determinants of readmission among individuals with diabetes minimises relapse and decreases diabetes associated morbidity and mortality. OBJECTIVES To explore the prevalence of depression and anxiety as well as determinants of readmission in individuals with diabetes from Harare, Zimbabwe. METHODS A cross sectional study was carried out at Parirenyatwa and Harare group of hospitals. Participants were recruited through purposive sampling and interviewed at the diabetic clinics. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale. Binary logistic regression was used to determine predictors of readmission. RESULTS In total 65 participants took part, 36.9% were males. The mean age ±SD was 44.89±14.2 years. Anxiety affected 40% and 20% were at risk of anxiety, while depression was reported in 27.7% and 30.8% were at risk of depression. Depression [OR=0.64, 95%CI: 0.42-0.97 (p=0.037)] and checking of blood glucose [OR=0.06, 95%CI: 0.01-0.71 (p=0.025)] were significant negative predictors of readmission among diabetic patients while anxiety was a significant positive predictor OR=1.55, 95%CI: 1.09-2.21 (p=0.015). CONCLUSIONS Mental health conditions in people living with diabetes are factors contributing to increased re admissions and are more prevalent with aging. Psychotherapy and education interventions are recommended for the elderly diabetic population.
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Affiliation(s)
- Prosper Chopera
- Department of Nutrition, Dietetics and Food Sciences, Faculty of Science, University of Zimbabwe, P.O. Box MP167, Mt Pleasant, Harare, Zimbabwe
| | - Sineke Glorious Mbambo
- Department of Nutrition, Dietetics and Food Sciences, Faculty of Science, University of Zimbabwe, P.O. Box MP167, Mt Pleasant, Harare, Zimbabwe
| | - Tonderayi Matthew Matsungo
- Department of Nutrition, Dietetics and Food Sciences, Faculty of Science, University of Zimbabwe, P.O. Box MP167, Mt Pleasant, Harare, Zimbabwe
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Hussein SA, Kithuka P, Otieno G, Yoos A, Kaugi R, Njeru C. Management of diabetes mellitus at the household level using community health strategy in Embu County, Kenya. Pan Afr Med J 2021; 39:35. [PMID: 34422158 PMCID: PMC8356939 DOI: 10.11604/pamj.2021.39.35.27753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/29/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction diabetes mellitus (DM) causes 1% of the mortality in Kenya and 2% of the population in Kenya has diabetes mellitus. Embu County was the 5th leading county in diabetes mellitus morbidity in Kenya in 2019. This study aimed at assessing the management of diabetes mellitus at the household level using the community health strategy in Embu County. Community health strategies in the county is implemented using Community Health Volunteers. Methods it was a cross-sectional study using 422 household participants in Embu County and 150 community health volunteers´ (CHVs). Key informant interviews were used on community health strategy managers involved in diabetes management programmes in the County. Data was analyzed using SPSS version 25. Results factors that were positively associated with effective management of DM at household level in the County were financial support and supervision of community health units, provision of tools and commodities, use of health information system, training of level of CHVs in management of hypertension and diabetes mellitus and subsequent knowledge on symptoms, defining and classifying DM, treatment, prescription of drugs, knowledge of risk factors of DM and prevention of DM at household level. Conclusion success of utilization of community health strategies for diabetes management will require adequate training of CHVs in management of hypertension and diabetes mellitus, financial support of community health units, adequate supervision of community health units, financial support of community health units, provision of tools and commodities and community health units (CHU) utilizing health information system.
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Affiliation(s)
- Salim Ali Hussein
- Department of Health Management and Informatics, School of Public Health, Kenyatta University, Nairobi, Kenya.,Improving Public Health Management for Action (IMPACT), Nairobi, Kenya.,National Government, Ministry of Health, Nairobi, Kenya
| | - Peter Kithuka
- Department of Health Management and Informatics, School of Public Health, Kenyatta University, Nairobi, Kenya
| | - George Otieno
- Department of Health Management and Informatics, School of Public Health, Kenyatta University, Nairobi, Kenya
| | - Alison Yoos
- Department of Health Management and Informatics, School of Public Health, Kenyatta University, Nairobi, Kenya
| | - Rosaline Kaugi
- Department of Health, Embu County Government, Embu, Kenya
| | - Cecelia Njeru
- Department of Health, Embu County Government, Embu, Kenya
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Kumah E, Otchere G, Ankomah SE, Fusheini A, Kokuro C, Aduo-Adjei K, A. Amankwah J. Diabetes self-management education interventions in the WHO African Region: A scoping review. PLoS One 2021; 16:e0256123. [PMID: 34403455 PMCID: PMC8370626 DOI: 10.1371/journal.pone.0256123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/01/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. MATERIALS AND METHODS The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. RESULTS Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. CONCLUSIONS The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.
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Affiliation(s)
- Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Faculty of Humanities, Center for Medicine and Society, University of Freiburg, Freiburg im Breisgau, Germany
| | - Samuel Egyakwa Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Aduo-Adjei
- Center for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Joseph A. Amankwah
- Department of Administration, Ankaase Methodist Hospital, Ankaase, Ghana
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Muchiri JW, Gericke GJ, Rheeder P. Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes: a randomized controlled trial. J Diabetes Metab Disord 2021; 20:293-306. [PMID: 34222067 PMCID: PMC8212224 DOI: 10.1007/s40200-021-00744-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM). METHODS A tertiary hospital outpatient adults (40-70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments). RESULTS Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months. CONCLUSIONS NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation. TRIAL REGISTRATION ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.
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Affiliation(s)
- Jane W. Muchiri
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
| | - Gerda J. Gericke
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
| | - Paul Rheeder
- School of Medicine, Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria, 0001 South Africa
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To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084095. [PMID: 33924494 PMCID: PMC8069177 DOI: 10.3390/ijerph18084095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
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Abate TW, Dessie G, Workineh Y, Gedamu H, Birhanu M, Ayalew E, Tirfie M, Endalamaw A. Non-adherence to self-care and associated factors among diabetes adult population in Ethiopian: A systemic review with meta-analysis. PLoS One 2021; 16:e0245862. [PMID: 33566861 PMCID: PMC7875372 DOI: 10.1371/journal.pone.0245862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/08/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Self-care practice among people with diabetes is not well-implemented in Ethiopia. So far, in Ethiopia, several observational studies have been done on self-care practice and its determinants in people with diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap. METHODS A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization's Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion of non-adherence to self-care practice in people with diabetes and the odds ratios of risk factors hindering to self-care practice after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD 42020149478. RESULTS We included 21 primary studies (with 7,134 participants) in this meta-analysis. The pooled proportion of non-adherence to self-care in the diabetes population was 49.91 (95% CI: 44.73-55.08, I2 = 89.8%). Male (Pooled Odds Ratio (POR): 1.84 95%CI; 1.04-2.64, I2 = 15.0%), having private glucometer (POR: 2.71; 95%CI: 1.46-3.95, I2 = 0.0%), short-term Diabetes Mellitus (DM) duration (POR: 3.69; 95%CI: 1.86-5.52, I2 = 0.0%), DM complication (POR: 2.22; 95%CI: 1.48-2.95, I2 = 0.0%), treatment satisfaction (POR: 1.8; 95% CI: 1.15-2.44, I2 = 0.0%), received diabetes self-management education (POR: 2.71; 95% CI: 1.46-3.95, I2 = 0.0%) and poor self-efficacy (POR: 3.09; 95% CI: 1.70-4.48, I2 = 0.0%) were statistically significant factors of non-adherence to self-care practice. CONCLUSIONS The overall pooled proportion of non-adherence to self-care among adult diabetes in Ethiopia was high. Further works would be needed to improve self-care practice in the diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and each domain of self-care practice according to diabetes self-management guideline.
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Affiliation(s)
- Teshager Weldegiorgis Abate
- Department of adult health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getenet Dessie
- Department of adult health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yinager Workineh
- Department of Pediatric and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Haileyesus Gedamu
- Department of adult health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Minyichil Birhanu
- Department of Pediatric and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Emiru Ayalew
- Department of adult health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Tirfie
- Department of nutrition and dietetics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatric and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Kashani F, Abazari P, Haghani F. Challenges and Strategies of Needs Assessment Implementing in Diabetes Self-management Education in Iran: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:437-443. [PMID: 33344217 PMCID: PMC7737838 DOI: 10.4103/ijnmr.ijnmr_10_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023]
Abstract
Background: Many diabetes educators in Iran do not have the necessary skills and competence for performing a needs assessment, and thus, cannot provide Diabetes Self-Management Education (DSME) to suit individual educational needs and conditions. The purpose of the present study was to explore and analyze needs assessment implementation in DSME and evaluate the barriers and the appropriate strategies from educators' viewpoints. Materials and Methods: The present qualitative study was conducted using a conventional content analysis approach with semi-structured and in-depth interviews and using a purposeful sampling method on 20 nurses, physicians, and endocrinologists. The data of this study were collected from April to October 2018. The interviews were analyzed using the content analysis method of Graneheim and Lundman. Results: Qualitative data analysis resulted in the emergence of two main categories of educational challenges of needs assessment and managerial challenges of needs assessment and four subcategories (lack of structured educational planning, lack of needs assessment practical patterns, managers' insufficient support and supervision, and managers' insufficient attention to motivational factors). Conclusions: Educational strategic planning, managers' obligation and support in designing practical patterns, and supervision tools to evaluate educators' performance in the needs assessment domain can result in the promotion of DSME needs assessment, the efficiency of plans, and the promotion of society's health.
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Affiliation(s)
- Fahimeh Kashani
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.,Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Parvaneh Abazari
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.,Nursing and Midwifery Sciences Development Research Center, Najafabad Branch Islamic Azad University, Najafabad, Iran
| | - Fariba Haghani
- Medical Education Research Center, Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran
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Coster S, Li Y, Norman IJ. Cochrane reviews of educational and self-management interventions to guide nursing practice: A review. Int J Nurs Stud 2020; 110:103698. [PMID: 32726709 DOI: 10.1016/j.ijnurstu.2020.103698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The burden of chronic disease on healthcare services worldwide continues to grow, and the increased development of educational interventions which help patients to better manage their own condition is evident internationally. OBJECTIVES This paper reports on findings of an updated review of Cochrane systematic reviews of interventions designed to improve patients' knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice. METHODS A broad search strategy was used to search the Cochrane Database of Systematic Reviews to identify reviews of patient education, self-management, and self-care studies. Two reviewers independently assessed eligibility for inclusion and extracted data from the reviews. FINDINGS From a total of 882 reviews, 63 met the inclusion criteria, and 900 studies were identified. Most (68%, n = 43) of the 63 reviews were judged by Cochrane reviewers to provide inadequate evidence of the effectiveness of the interventions reviewed. Information on the profession of the person delivering the intervention was often not available, although 78% (n = 49) of reviews mentioned that nurses were involved in a proportion of studies delivering interventions either independently or as part of a multi-professional team. CONCLUSION Educational programmes have definite benefits for patients suffering from asthma, chronic obstructive pulmonary disorder and stroke, and are promising in areas such as diabetes, epilepsy, cancer care, and mental health. However, it still is not clear what the active ingredients of many successful interventions are. Further research is needed to establish the impact of technology on programme delivery, and to develop programmes tailored for patients with multiple health problems.
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Affiliation(s)
- Samantha Coster
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Yan Li
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Ian James Norman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Alsunni AA, Albaker WI, Almansour AH, Alenazi AS, Alaftan MS, Badar A. Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic. Diabetes Metab Syndr Obes 2020; 13:151-159. [PMID: 32021361 PMCID: PMC6982441 DOI: 10.2147/dmso.s241496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/09/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice. METHODS A total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21. RESULTS The mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p<0.041), education (OR: 0.068, 95% CI: 0.008,0.594, p<0.015) and family history (OR: 5.086, 95% CI: 1.095, 23.630 p<0.038) were identified as independent determinants of the total score. CONCLUSION Gender, Family history of diabetes and Education are determinants of knowledge, attitude and practice regarding fasting during Ramadan in the T2DM patients. A significant knowledge practice gap exists that necessitates further strengthening of the Pre-Ramadan education program for T2DM patients.
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Affiliation(s)
- Ahmed Abdulrahman Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
- Correspondence: Ahmed Abdulrahman Alsunni Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia Email
| | - Waleed Ibrahim Albaker
- Department of Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Abdulelah Hassan Almansour
- Department of Family & Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Abdulaziz Saud Alenazi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Mohammed S Alaftan
- Department of Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ahmed Badar
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Mikhael EM, Hassali MA, Hussain SA. Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review. Diabetes Metab Syndr Obes 2020; 13:117-138. [PMID: 32021358 PMCID: PMC6968799 DOI: 10.2147/dmso.s232958] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
AIM This review study aimed to determine the effectiveness and factors affecting the success of DSME programs in T2DM patients living in ME countries. METHODS An extensive manual literature search was conducted using PubMed and Google Scholar for clinical trials assessing the effect of diabetes self-management education (DSME) for type 2 diabetes mellitus patients in Middle East countries. Information from the included studies was summarized in relation to study population, sample size, duration of follow-up, characteristics of DSME program, and follow-up time, besides in addition to parameters used in assessment, results, and conclusions. The risk of bias in the included studies was assessed using the Cochrane risk of bias tool. The effect of DSME on clinical and patient-reported outcomes was measured by calculation of the percentage of DSME studies that produce a significant improvement in these outcomes for patients in intervention group as compared to those in control group. Additionally, the effect of DSME on each clinical outcome was assessed by calculating the mean for the absolute effect of DSME on that outcome. RESULTS Twelve studies were included in this review. Heterogeneity was found among included studies in terms of DSME program characteristics, the enrolled patients, duration of follow-up, assessment methods, and obtained outcomes. All clinical glycemic outcomes (glycosylated hemoglobin, fasting, and non-fasting blood glucose), lipid profile (total cholesterol and triglycerides), and body mass index were significantly improved for patients in intervention group as compared to those in control group in at least 60% of the included studies. All patients' reported outcomes (medication adherence, self-management behavior, knowledge, self-efficacy, health belief and quality of life) were significantly improved by the DSME program. CONCLUSION DSME programs are highly effective in improving glycemic control, lipid profile and BMI, and modestly effective in improving BP. Thus, they can reduce the risks of developing diabetes complications. Patient diabetes knowledge, DSM behaviors, adherence to medications, self-efficacy, and quality of life can also be significantly improved by DSME.
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Affiliation(s)
- Ehab Mudher Mikhael
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
- Correspondence: Ehab Mudher Mikhael Email
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
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Hailu FB, Moen A, Hjortdahl P. Diabetes Self-Management Education (DSME) - Effect on Knowledge, Self-Care Behavior, and Self-Efficacy Among Type 2 Diabetes Patients in Ethiopia: A Controlled Clinical Trial. Diabetes Metab Syndr Obes 2019; 12:2489-2499. [PMID: 31819574 PMCID: PMC6890192 DOI: 10.2147/dmso.s223123] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/01/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Diabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients' self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy. PATIENTS AND METHODS A before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups. RESULTS At the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy. CONCLUSION Our study found significant improvements in the intervention participants' diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia. TRIAL REGISTRATION ClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Anne Moen
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per Hjortdahl
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Chaves FA, Cecilio SG, Reis IA, Pagano AS, Torres HDC. Translation and cross-cultural adaptation of the Behavior Change Protocol for educational practices in Diabetes Mellitus. Rev Lat Am Enfermagem 2019; 27:e3164. [PMID: 31432918 PMCID: PMC6703097 DOI: 10.1590/1518-8345.2908.3164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus. METHOD methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus. RESULTS the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85. CONCLUSION results showed content validity indicating the instrument's successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.
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Affiliation(s)
- Fernanda Azeredo Chaves
- Prefeitura de Belo Horizonte, Coordenação de Atenção à Saúde da
Mulher, Belo Horizonte, MG, Brasil
| | - Sumaya Giarola Cecilio
- Universidade Federal de Minas Gerais, Departamento de Enfermagem
Aplicada, Belo Horizonte, MG, Brasil
- Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível
Superior (CAPES), Brasil
| | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais, Instituto de Ciências Exatas,
Belo Horizonte, MG, Brasil
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17
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Punna M, Kettunen T, Bagnall AM, Kasila K. Implementation and Outcomes of Lay Health Worker-Led Self-Management Interventions for Long-Term Conditions and Prevention: A Systematic Review. HEALTH EDUCATION & BEHAVIOR 2019; 46:1045-1072. [PMID: 31387404 DOI: 10.1177/1090198119863842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to systematically review lay health worker (LHW)-led self-management interventions for adults with long-term conditions to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO, and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes (n = 29), cardiovascular diseases (n = 8), and those at risk of cardiovascular diseases (n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of 1 day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and noneffective interventions. The review found that LHW-led interventions have potential in promoting self-management in long-term condition. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.
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Affiliation(s)
- Mari Punna
- University of Jyvaskyla, Jyvaskyla, Finland.,JAMK University of Applied Sciences, Jyvaskyla, Finland
| | - Tarja Kettunen
- University of Jyvaskyla, Jyvaskyla, Finland.,Central Finland's Health Care District, Finland
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18
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Nkomani S, Ruskaniko S, Blaauw R. The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1641272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sanele Nkomani
- Division of Human Nutrition, Stellenbosch University, Cape Town, South Africa
| | | | - Renée Blaauw
- Division of Human Nutrition, Stellenbosch University, Cape Town, South Africa
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19
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Muchiri JW, Gericke GJ, Rheeder P. Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1632127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jane W Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - Gerda J Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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20
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Alhuwail D, Abduo H, Alqabandi N, Abu-Ghefreh A, Dawwas B, Halawa N. Engagement and Usage Patterns of a Diabetes Education Website Tailored for Arabic Speakers: A Case Study of a Diabetes Website from Kuwait. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2019. [DOI: 10.1080/15398285.2018.1547088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dari Alhuwail
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- College of Computing Sciences & Engineering, Kuwait University, Kuwait City, Kuwait
| | - Heba Abduo
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Naeema Alqabandi
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ala’a Abu-Ghefreh
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Basil Dawwas
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nadine Halawa
- Pharmacy Department, IWK Hospital, Halifax, Nova Scotia, Canada
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21
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Pizzol D, Veronese N, Quaglio G, Di Gennaro F, Deganello D, Stubbs B, Koyanagi A. The association between diabetes and cataract among 42,469 community-dwelling adults in six low- and middle-income countries. Diabetes Res Clin Pract 2019; 147:102-110. [PMID: 30529577 DOI: 10.1016/j.diabres.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/13/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cataract is a major cause of visual impairment in people with diabetes, yet a paucity of data is available in low- and middle-income countries (LMICs) on this comorbidity. Thus we assessed the association between diabetes and cataract in 6 LMICs. METHODS Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) was analyzed (n = 42,469 aged ≥18 years). Five years information on self-reported diagnosis of cataract was collected. Three definitions for cataract were used: (a) Self-reported diagnosis and/or past 12-month symptoms; (b) Solely self-reported diagnosis; and (c) Surgical treatment for cataract in the past five years. Diabetes was based on self-reported diagnosis. Multivariable logistic regression was conducted to assess the associations. RESULTS Overall, the prevalence of diabetes was 3.1% (95%CI = 2.7-3.5%) and that of cataract based on the three different definitions was: (a) 13.3% (95%CI = 12.4-14.3%); (b) 4.4% (95%CI = 3.9-4.8%), (c) 1.7% (95%CI = 1.5-2.0%). After adjustment the association was significantly elevated: (a) OR = 2.10 (95%CI = 1.59-2.76); (b) OR = 2.62 (95%CI = 2.00-3.42); (c) OR = 2.80 (95%CI = 1.78-4.40). These associations were particularly pronounced among those aged <50 years. CONCLUSIONS A strong association between diabetes and cataract was observed in LMICs. Considering the impact on health and quality of life and the limited treatment options especially for cataract it is mandatory to promote the prevention through bi-directional screening and treatment.
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Affiliation(s)
- Damiano Pizzol
- Operational Research Unit, Doctors with Africa, Mozambique.
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Gianluca Quaglio
- European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | | | - Davide Deganello
- Department of Neurosciences, Ophthalmology Unit, University of Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Muchiri JW, Gericke GJ, Rheeder P. Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2018. [DOI: 10.1080/16089677.2018.1541211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- JW Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - GJ Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - P Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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23
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Gathu CW, Shabani J, Kunyiha N, Ratansi R. Effect of diabetes self-management education on glycaemic control among type 2 diabetic patients at a family medicine clinic in Kenya: A randomised controlled trial. Afr J Prim Health Care Fam Med 2018; 10:e1-e9. [PMID: 30456964 PMCID: PMC6244221 DOI: 10.4102/phcfm.v10i1.1762] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/26/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background Diabetes self-management education (DSME) is a key component of diabetes care aimed at delaying complications. Unlike usual care, DSME is a more structured educational approach provided by trained, certified diabetes educators (CDE). In Kenya, many diabetic patients are yet to receive this integral component of care. At the family medicine clinic of the Aga Khan University Hospital (AKUH), Nairobi, the case is no different; most patients lack education by CDE. Aim This study sought to assess effects of DSME in comparison to usual diabetes care by family physicians. Setting Family Medicine Clinic, AKUH, Nairobi. Methods Non-blinded randomised clinical trial among sub-optimally controlled (glycated haemoglobin (HbA1c) ≥ 8%) type 2 diabetes patients. The intervention was DSME by CDE plus usual care versus usual care from family physicians. Primary outcome was mean difference in HbA1c after six months of follow-up. Secondary outcomes included blood pressure and body mass index. Results A total of 220 diabetes patients were screened out of which 140 met the eligibility criteria and were randomised. Around 96 patients (69%) completed the study; 55 (79%) in the DSME group and 41 (59%) in the usual care group. The baseline mean age and HbA1c of all patients were 48.8 (standard deviation [SD]: 9.8) years and 9.9% (SD: 1.76%), respectively. After a 6-month follow-up, no significant difference was noted in the primary outcome (HbA1c) between the two groups, with a mean difference of 0.37 (95% confidence interval: -0.45 to 1.19; p = 0.37). DSME also made no remarkable change in any of the secondary outcome measures. Conclusion From this study, short-term biomedical benefits of a structured educational approach seemed to be limited. This suggested that offering a short, intensified education programme might have limited additional benefit above and beyond the family physicians’ comprehensive approach in managing chronic conditions like diabetes.
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Hailu FB, Hjortdahl P, Moen A. Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia. Front Public Health 2018; 6:302. [PMID: 30406070 PMCID: PMC6206899 DOI: 10.3389/fpubh.2018.00302] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Unlike in developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well-studied in the African context. Thus, this study sought to determine effects of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia. Methods: Before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to a nurse-led DSME group and 104 to a treatment-as-usual (comparison) group. A nurse-led DSME with six sessions supported with illustrative pictures handbooks and fliers was customized to local conditions and delivered by trained nurses over 9 months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c ≤ 7%). We used chi-square test and mixed model analysis. Results: Seventy-eight (67%) and 64 (62%) participants assigned to intervention and comparison, respectively completed the study, and included in the final analysis. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, change in the proportion of participants with target HbA1c and end-line mean HbA1c difference between the groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg, respectively. Conclusion: After 9 months of nurse-led DSME, HbA1c was significantly reduced within both groups but there was no significant difference in HbA1c between groups. The intervention also showed some clinically significant effects on blood pressure and FBS. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway.,School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Per Hjortdahl
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
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Stephani V, Opoku D, Beran D. Self-management of diabetes in Sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:1148. [PMID: 30268115 PMCID: PMC6162903 DOI: 10.1186/s12889-018-6050-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saharan Africa. METHOD Relevant databases including PubMed, Web of Science and Google Scholar were searched up to September 2016. Studies reporting self-management behavior of people with type 2 diabetes mellitus and living in sub-Saharan Africa were included. RESULTS A total of 550 abstracts and 109 full-text articles were assessed. Forty-three studies, mainly observational, met the inclusion criteria. The studies showed that patients rarely self-monitored their glucose levels, had low frequency/duration of physical activity, moderately adhered to recommended dietary and medication behavior, had poor level of knowledge regarding diabetes related complications and sought traditional or herbal medicines beside of their biomedical treatment. The analysis also revealed a lack of studies on psychosocial aspects. CONCLUSION Except for the psychosocial area, there is a good amount of recent studies on self-management behavior of type 2 diabetes mellitus sub-Saharan Africa. These studies indicate that self-management in sub-Saharan Africa is poor and therefore a serious threat to the health of individuals and the health systems capacity.
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Affiliation(s)
- Victor Stephani
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Daniel Opoku
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Genève, Switzerland
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Elliott JA, Das D, Cavailler P, Schneider F, Shah M, Ravaud A, Lightowler M, Boulle P. A cross-sectional assessment of diabetes self-management, education and support needs of Syrian refugee patients living with diabetes in Bekaa Valley Lebanon. Confl Health 2018; 12:40. [PMID: 30214472 PMCID: PMC6134700 DOI: 10.1186/s13031-018-0174-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with diabetes require knowledge and skills to self-manage their disease, a challenging aspect of treatment that is difficult to address in humanitarian settings. Due to the lack of literature and experience regarding diabetes self-management, education and support (DSMES) in refugee populations, Medecins Sans Frontieres (MSF) undertook a DSMES survey in a cohort of diabetes patients seen in their primary health care program in Lebanon. METHODS Structured interviews were conducted with diabetes patients in three primary care clinics between January and February 2015. Scores (0-10) were calculated to measure diabetes core knowledge in each patient (the DSMES score). Awareness of long-term complications and educational preferences were also assessed. Analyses were conducted using Stata software, version 14.1 (StataCorp). Simple and multiple linear regression models were used to determine associations between various patient factors and the DSMES Score. RESULTS A total of 292 patients were surveyed. Of these, 92% had type 2 diabetes and most (70%) had been diagnosed prior to the Syrian conflict. The mean DSMES score was 6/10. Having secondary education, previous diabetes education, a 'diabetes confidant', and insulin use were each associated with a higher DSMES Score. Lower scores were significantly more likely to be seen in participants with increasing age and in patients who were diagnosed during the Syrian conflict. Long-term complications of diabetes most commonly known by patients were vision related complications (68% of patients), foot ulcers (39%), and kidney failure (38%). When asked about the previous Ramadan, 56% of patients stated that they undertook a full fast, including patients with type 1 diabetes. Individual and group lessons were preferred by more patients than written, SMS, telephone or internet-based educational delivery models. CONCLUSIONS DSMES should be patient and context appropriate. The variety and complexities of humanitarian settings provide particular challenges to its appropriate provision. Understanding patient baseline DSMES levels and needs provides a useful basis for humanitarian organizations seeking to provide diabetes care.
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Affiliation(s)
- James A. Elliott
- Médecins Sans Frontières/Doctors Without Borders Canada, 551 Adelaide St W, Toronto, ON M5V 0N8 Canada
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
- Karolinska Institute, Stockholm, Sweden
- T1International, Cheltenham, UK
| | - Debashish Das
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | | | - Fabien Schneider
- Médecins Sans Frontières/Doctors Without Borders Canada, 551 Adelaide St W, Toronto, ON M5V 0N8 Canada
| | - Maya Shah
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Annette Ravaud
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Maria Lightowler
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
| | - Philippa Boulle
- Médecins Sans Frontières, Rue de Lausanne 78, Geneva, 1202 Switzerland
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Dube L, Rendall-Mkosi K, Van den Broucke S, Bergh AM, Mafutha NG. Self-Management Support Needs of Patients with Chronic Diseases in a South African Township: A Qualitative Study. J Community Health Nurs 2018; 34:21-31. [PMID: 28156143 DOI: 10.1080/07370016.2017.1260983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the need for chronic disease self-management strategies in developing countries, few studies have aimed to contextually adapt programs; yet culture has a direct impact on the way people view themselves and their environment. This study aimed to explore the knowledge, attitudes, and self-management needs and practices of patients with chronic diseases. Four patient focus groups (n = 32), 2 patient interviews, group observations, and key informant interviews (n = 12) were conducted. Five themes emerged: health-system and service-provision challenges, healthcare provider attitudes and behavior, adherence challenges related to medication and lifestyle changes, patients' personal and clinic experiences and self-management tool preferences. The findings provide a window of opportunity for the development of contextually adapted self-management programs for community health nursing in developing countries.
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Affiliation(s)
- Loveness Dube
- a Psychological Sciences Research Institute , Catholic University of Louvain , Louvain-la-Neuve , Belgium.,b Institute of Health and Society , Catholic University of Louvain , Brussels , Belgium
| | - Kirstie Rendall-Mkosi
- c School of Health Systems and Public Health , University of Pretoria , South Africa
| | - Stephan Van den Broucke
- a Psychological Sciences Research Institute , Catholic University of Louvain , Louvain-la-Neuve , Belgium
| | - Anne-Marie Bergh
- c School of Health Systems and Public Health , University of Pretoria , South Africa.,d South African Medical Research Council Unit for Maternal and Infant Health Care Strategies , University of Pretoria , South Africa
| | - Nokuthula G Mafutha
- e Department of Nursing Education , University of the Witwatersrand , Johannesburg , South Africa
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Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, Zhang X, Ji L. The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. PATIENT EDUCATION AND COUNSELING 2018; 101:1427-1432. [PMID: 29622281 DOI: 10.1016/j.pec.2018.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus. METHODS Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education. RESULTS A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group. CONCLUSION The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved. PRACTICE IMPLICATIONS Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.
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Affiliation(s)
- Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Baoting Yao
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Lin Xu
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Danyang Wang
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China; Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China
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Effects of Self-management Education Through Telephone Follow-up in Diabetic Patients. Health Care Manag (Frederick) 2018; 36:273-281. [PMID: 28738397 DOI: 10.1097/hcm.0000000000000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is expected that the number of people living with diabetes rise especially in low- and middle-income countries. In Iran, more than four million adults have diabetes mellitus, and self-management education is essential for effective diabetes self-care. This study aimed to investigate the effect of self-management education with telephone follow-up in diabetic patients of rural areas of Fars province in Lamerd city, Iran. In this experimental study, 64 participants were randomly assigned to intervention and control groups (32 patients for each group). In the intervention group, the participants attended four educational sessions, each lasting 90 minutes. The control group received the usual care. Outcome measures were clinical variables and the patients' scores in Diabetes Self-Management Questionnaire (DSMQ) in the preintervention and postintervention phases. Effects of the intervention were analyzed using Mann-Whitney U test and analysis of covariance. Data of 60 patients (30 in each group) were analyzed. There were significant differences between the two groups in fasting blood sugar after 3 months of intervention. There was a significant difference between the intervention and control groups in DSMQ sum scale after adjusting for baseline value. In subscales of DSMQ, there were significant differences between the intervention and control groups in glucose management, dietary control, and physical activity, whereas no significant difference was found in health care use between the intervention and control groups. Self-management education with telephone follow-up in diabetic patients in rural areas is effective, especially in improving fasting blood sugar level and increasing scores of patients based on DSMQ.
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Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali. PLoS One 2018; 13:e0191262. [PMID: 29357380 PMCID: PMC5777645 DOI: 10.1371/journal.pone.0191262] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/28/2017] [Indexed: 01/11/2023] Open
Abstract
Objectives Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country (Mali). Methods We conducted an open-label randomised controlled trial. A total of 151 adults (76% women, mean age 52.5) with type 2 diabetes (HbA1c≥8%), treated in the diabetes consultation units of two secondary health centres in Bamako, were allocated to peer-led structured patient education (n = 76) or conventional care alone (n = 75). The intervention group received 1 year of culturally tailored structured patient education (3 courses of 4 sessions) delivered in the community by five trained peer educators. Both groups underwent conventional diabetes monitoring and follow-up. Primary outcome was the mean absolute change in HbA1c from baseline to 12 months. Results 177 education sessions were delivered to the intervention group. Patient attrition was 8%. From baseline to 12 months, the decrease in HbA1c levels was 1.05% (SD = 2.0; CI95%: 1.54;-0.56) in the intervention group compared with 0.15% (SD = 1.7; CI95%: -0.56; 0.26) in the control group, p = 0.006. Mean BMI change was -1.65 kg/m2 (SD = 2.5; CI95%: -2.25; -1.06) in the intervention group and +0.05 kg/m2 (SD = 3.2; CI95%: -0.71; 0.81) in the control group, p = 0.0005. Mean waist circumference decreased by 3.34 cm (SD = 9.3; CI95%: -5.56;-1.13) in the intervention group and increased by 2.65 cm (SD = 10.3; CI95%: 0.20; 5.09) in the control group, p = 0.0003. Conclusions Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali yielded substantial improvements in glycaemic control and anthropometric parameters. This is of importance for the scaling up of efficient interventions in low-resource settings in the future. Trial registration ClinicalTrials.gov NCT01485913
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Velázquez-López L, Muñoz-Torres AV, Medina-Bravo P, Vilchis-Gil J, Klϋnder-Klϋnder M, Escobedo-de la Peña J. Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial. Endocrine 2017; 58:236-245. [PMID: 28921414 DOI: 10.1007/s12020-017-1416-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. RESEARCH QUESTION What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes? PATIENTS AND METHODS A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded. RESULTS Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (-41.2 mg/dL; 95%CI -52.0 to -30.5), 14 (-27.8 mg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6 mg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p < 0.05). Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05). CONCLUSION Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.
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Affiliation(s)
- Lubia Velázquez-López
- Unidad de Investigación en Epidemiología Clínica, Hospital "Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), México City, Mexico.
| | - Abril Violeta Muñoz-Torres
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico
| | - Patricia Medina-Bravo
- Departamento de Endocrinología, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SSA), México City, Mexico
| | - Jenny Vilchis-Gil
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SSA), México City, Mexico
| | - Miguel Klϋnder-Klϋnder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SSA), México City, Mexico
| | - Jorge Escobedo-de la Peña
- Unidad de Investigación en Epidemiología Clínica, Hospital "Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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Flood D, Hawkins J, Rohloff P. A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala. Prev Chronic Dis 2017; 14:E65. [PMID: 28796597 PMCID: PMC5553353 DOI: 10.5888/pcd14.170052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Diabetes self-management education (DSME) is a fundamental element of type 2 diabetes care. Although 75% of adults with diabetes worldwide live in low-income and middle-income countries (LMICs), limited DSME research has been conducted in LMICs. The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala. METHODS We conducted a prospective study of a DSME intervention using a quasi-experimental, single-group pretest-posttest design. We enrolled 90 participants in the intervention, which consisted of 6 home visits (May 2014-July 2016) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan populations. Primary outcomes were changes in mean hemoglobin A1c (HbA1c) and mean systolic and diastolic blood pressure at baseline and at 12 months. Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion. RESULTS HbA1c decreased significantly from baseline to 12 months (absolute mean change, -1.5%; 95% confidence interval [CI], -1.9% to -1.0%; P < .001). Systolic blood pressure also improved significantly at 12 months (-6.2 mm Hg; 95% CI, -10.1 to -2.2 mm Hg; P = .002); changes in diastolic blood pressure were not significant (-1.6 mm Hg; 95% CI, -3.9 to -0.7 mm Hg; P = .17). We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion. CONCLUSION DSME interventions can be successfully delivered in a setting with an underresourced health system, high poverty rate, and unique cultural characteristics like Mayan Guatemala. Our findings point to the need for more DSME research in resource-limited settings globally.
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Affiliation(s)
- David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.,Medicine Pediatric Residency Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Peter Rohloff
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115.
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Flood D, Mux S, Martinez B, García P, Douglas K, Goldberg V, Lopez W, Rohloff P. Implementation and Outcomes of a Comprehensive Type 2 Diabetes Program in Rural Guatemala. PLoS One 2016; 11:e0161152. [PMID: 27583362 PMCID: PMC5008811 DOI: 10.1371/journal.pone.0161152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background The burden of chronic, non-communicable diseases such as diabetes is growing rapidly in low- and middle-income countries. Implementing management programs for diabetes and other chronic diseases for underserved populations is thus a critical global health priority. However, there is a notable dearth of shared programmatic and outcomes data from diabetes treatment programs in these settings. Program Description We describe our experiences as a non-governmental organization designing and implementing a type 2 diabetes program serving Maya indigenous people in rural Guatemala. We detail the practical challenges and solutions we have developed to build and sustain diabetes programming in this setting. Methods We conduct a retrospective chart review from our electronic medical record to evaluate our program’s performance. We generate a cohort profile, assess cross-sectional indicators using a framework adapted from the literature, and report on clinical longitudinal outcomes. Results A total of 142 patients were identified for the chart review. The cohort showed a decrease in hemoglobin A1C from a mean of 9.2% to 8.1% over an average of 2.1 years of follow-up (p <0.001). The proportions of patients meeting glycemic targets were 53% for hemoglobin A1C < 8% and 32% for the stricter target of hemoglobin A1C < 7%. Conclusion We first offer programmatic experiences to address a gap in resources relating to the practical issues of designing and implementing global diabetes management interventions. We then present clinical data suggesting that favorable diabetes outcomes can be attained in poor areas of rural Guatemala.
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Affiliation(s)
- David Flood
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Medicine-Pediatrics Residency Program, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sandy Mux
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Boris Martinez
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Pablo García
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Internal Medicine Residency Program, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States of America
| | - Kate Douglas
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Vera Goldberg
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Waleska Lopez
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Coppola A, Sasso L, Bagnasco A, Giustina A, Gazzaruso C. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 2016; 53:18-27. [PMID: 26494579 DOI: 10.1007/s12020-015-0775-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/10/2015] [Indexed: 12/25/2022]
Abstract
The management of type 2 diabetes mellitus includes ability and empowerment of the patient to change lifestyle, maintain an adequate diet and physical activity, manage the disease, and follow a specific program of periodic medical checks and education sessions. In addition, the patient should be able to correctly identify and adequately solve problems related to the disease and actively collaborate with the healthcare system. To obtain these goals, therapeutic patient education (TPE) is now considered a crucial element not only in the treatment but also in the prevention of type 2 diabetes. Several trials showed that TPE is able to improve clinical, lifestyle, and psycho-social outcomes. Nevertheless, studies have not clarified the ideal characteristics of a comprehensive patient education program in clinical practice. Other work is needed to answer open questions regarding the type of PTE (individual or group education), themes, frequency and number of education sessions, contact time between educator and patient, background of educators, use of new technologies, and barriers to self-management. The present review discusses these points on the basis of the most recent data of the literature.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Andrea Giustina
- Chair of Endocrinology, A.O. Spedali Civili, University of Brescia, Brescia, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy
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Lin S, Ramulu P, Lamoureux EL, Sabanayagam C. Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review. Clin Exp Ophthalmol 2016; 44:300-20. [DOI: 10.1111/ceo.12745] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/26/2016] [Accepted: 03/08/2016] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute; Singapore
- Office of Clinical Sciences; Duke-NUS Medical School; Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute; Singapore
- Office of Clinical Sciences; Duke-NUS Medical School; Singapore
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Maia MA, Reis IA, Torres HDC. Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge. Rev Esc Enferm USP 2016; 50:59-65. [PMID: 27007421 DOI: 10.1590/s0080-623420160000100008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/17/2015] [Indexed: 02/08/2023] Open
Abstract
Abstract OBJECTIVE Check the relationship between the users' contact time in educational programs and self-care and knowledge variables in diabetes mellitus. METHOD A longitudinal study with a quantitative approach with the participation, in the initial phase, of 263 users linked to Basic Health Units in Belo Horizonte, Brazil during the years 2012 and 2013. The data were collected with respect to the total contact time of the users' participation in the educational program as regards knowledge and self-care in acquired diabetes mellitus. The data were analyzed using the Student t-test for comparison of means, considering a 0.05 significance level. RESULTS The final sample included 151 users. The analysis showed that the improvement in self-care scores was statistically higher during an educational intervention of eight hours or more (p-value <0.05). In relation to the scores for knowledge, there was a statistically significant improvement at the end of the educational program. It was not possible to identify a value for the contact time from which there was an increase in mean scores for the ability of knowledge. CONCLUSION To improve the effectiveness of the promotion of skills related to knowledge and self-care in diabetes mellitus, it is necessary to consider the contact time as a relevant factor of the educational program.
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Dube L, Van den Broucke S, Dhoore W, Kalweit K, Housiaux M. An Audit of Diabetes Self-Management Education Programs in South Africa. J Public Health Res 2015; 4:581. [PMID: 26753160 PMCID: PMC4693339 DOI: 10.4081/jphr.2015.581] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetes is a significant contributor to the burden of disease worldwide. Since its treatment requires extensive self-care, self-management education is widely recommended, particularly in resource limited settings. This study aimed to review the current state of policies and implementation of diabetes self-management education (DSME) in South Africa, with a specific focus on cultural appropriateness. Design and Methods: The audit involved a review of policy documents and semi-structured questionnaires with providers and experts in public and private health services. Forty-four respondents were interviewed. Documents were analysed with reference to the International Standards for Diabetes Education from the International Diabetes Federation. Data were entered and analysed in excel to give a description of the DSME programs and ad hoc interventions. Results: Three guidelines for Type 2 diabetes and two for chronic diseases were retrieved, but none were specifically dedicated to DSME. Five structured programs and 22 ad-hoc interventions were identified. DSME is mostly provided by doctors, nurses and dieticians and not consistently linked to other initiatives such as support groups. Health education materials are mainly in English with limited availability. Conclusions: DSME in South Africa is limited in scope, content and consistency, especially in the public services. A National curricula and materials for diabetes education need to be developed and adapted to the socio-economic context, culture and literacy levels of the target populations. It is recommended that DSME would be addressed in national policies and guidelines to guide the development and implementation of standardised programs. Significance for public health Diabetes significantly contributes to the global burden of disease. This burden is especially felt in developing countries, where resources are limited and the health system simultaneously has to deal with communicable and non-communicable diseases. While there is a growing body of literature on the development and implementation of diabetes self-management education, nearly all programs originate from developed countries. Very little is known about the current state of diabetes self-management education in developing countries. By focusing on diabetes self-management education in Southern Africa, the current paper provides policy makers and decision makers in South Africa with information that will help decide on where and how to intervene with regard to diabetes self-management education. The paper also has relevance for decision makers from other developing countries by providing recommendations on diabetes policies and diabetes self-management education.
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Affiliation(s)
- Loveness Dube
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
| | - William Dhoore
- lnstitute of Health and Society, Universite Catholique de Louvain , Brussels, Belgium
| | - Kerry Kalweit
- School of Health Systems and Public Health, University of Pretoria , South Africa
| | - Marie Housiaux
- Psychological Sciences Research Institute, Universite Catholique de Louvain , Louvain-la-Neuve, Belgium
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Nwankwo CU, Ezenwaka CE, Onuoha PC, Agbakoba NR. Implementing diabetes self-management education (DSME) in a Nigerian population: perceptions of practice nurses and dieticians. Arch Physiol Biochem 2015; 121:123-7. [PMID: 26112931 DOI: 10.3109/13813455.2015.1031140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hyperglycaemic complication is the most common cause of hospitalization amongst diabetes patients in Nigeria. Research showed that diabetes self-management education (DSME) assists in controlling hyperglycaemia in diabetes patients. We assessed the opinions of practice nurses and dieticians on implementing DSME in a Nigerian population. 517 nurses and dieticians completed a self-administered questionnaire tool. Results showed that the majority of the participants agreed that DSME in a Nigerian population will assist patients (88.3%) and assist to reduce diabetes complications (91.4%). While only 34% of all participants believed that their establishments were prepared to implement DSME, a large proportion of the participants agreed that their work places do not have enough qualified health personnel (62.4%), educational facilities (65.8%) and economic resources (65.6%) to embark on DSME. These constitute significant barriers for effective DSME and demand that strategic investment in human and material resources for DSME is needed in this population of a developing country.
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Affiliation(s)
- Clementina U Nwankwo
- Faculty of Health Sciences and Technology, Nnamdi Azikiwe University , Nnewi Campus , Nigeria , and
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