Effects of a nurse-led, community-based self-management programme for people with type 2 diabetes in western ethiopia : a pilot randomised controlled trial

Abstract

Background Diabetes is becoming a public health threat, with more than a half-billion adults living with this illness globally. Ethiopia ranks fourth based on the number of diabetes cases in Africa, with type 2 diabetes (T2D) as the most prevalent type. Effective management is necessary to curb this disease. In Africa, the management of diabetes is suboptimal and challenged by the lack of understanding of local foods, misconceptions, lack of family support and a poor healthcare system. Meanwhile, amongst African Americans, diabetes self-management interventions (DSM) are ineffective in controlling glycosylated haemoglobin (HbA1c) and improving self-management behaviours. However, the interventions' feasibility and effectiveness on Ethiopians with diabetes are unknown. Aim The aim of the pilot randomised controlled trial (RCT) was to examine the feasibility, acceptability and preliminary effects of a nurse-led, community-based DSM education and support (DSMES) programme on the clinical, behavioural, psychological and environmental outcomes of people with diabetes and their family caregiver's supportive behaviour. Methods and materials The doctoral study is divided into three phases. In Phase I, a systematic review and a meta-analysis were conducted based on 11 RCTs to review and synthesise the effectiveness of DSMES interventions on the diabetic-related outcomes on Africans with diabetes. Lack of the culturally specific nutrition knowledge, misconception about diabetes and its management, gap in family support, lack of practical tools to educate the self-care activities and lack of community-based intervention were identified as the gaps. The findings from this review were then used to guide the intervention development of the pilot RCT. In Phase II, a DSEMS programme was developed based on social cognitive theory (SCT) and the Phase I results. In Phase III, a two-arm parallel-group pilot RCT was conducted for people with diabetes-family caregiver dyads. Seventy-six dyads were recruited in Nekemte Specialised Hospital over three months, with 38 dyads randomly allocated either to the intervention arm to receive 12 hours of DSMES programme intervention besides the usual care or to the control group to continue the usual care. The intervention was delivered by nurses in the community setting and supported with an educational handbook, flyers and videos. The feasibility outcomes (recruitment, retention and item-level missing data rates) and the preliminary efficacy of the DSMES programme on the clinical, diabetes-related quality of life (DQOL), self-management practise, support status and family caregiver's supportive behaviour were assessed. Furthermore, the intervention fidelity and acceptability were assessed for the intervention group. The feasibility outcomes were computed using rates/percentages. Independent t-tests and chi-squared tests were computed to examine the groups' comparability in demographics as produced by randomisation. Generalised estimating equations models were computed to test for the preliminary effects of the DSMES programme on the outcomes, and Cohen's d was calculated to estimate the between-group effect size of the intervention. Results The results of the pilot RCT showed the feasibility of recruiting and retaining the participants in the study. The eligibility rate, recruitment rate, intervention compliance rate of the study was 39.2%, 85.4% and 97.4% respectively. The item-level missing rate ranges between 0 to 3.5%. The study found that the DSMES programme can produce promising preliminary results in improving HbA1c, triglycerides, self-management practise, DQOL, support needed and support received and family caregiver's supportive behaviour. The effect sizes ranged from small to large. The DSMES programme is acceptable to the participating dyads receiving the DSMES programme. Conclusion The SCT-guided, nurse-led and community-based DSMES programme can produce a promising positive effect on controlling blood glucose, improving self-management behaviours and enhancing the quality of life of people with diabetes. It can also produce promising positive effects on the perceived support from their family/friends and improving the family's supportive behaviour.