THE EFFECTIVENESS OF DIABETES SELF-MANAGEMENT EDUCATION TRAINING AMONG INDIVIDUALS WITH TYPE 2 DIABETES MELLITUS IN RURAL NIGERIA

Y. Said¹, T. Steyl¹, J.S. Phillips¹

¹University of the Western Cape, Physiotherapy, Bellville, South Africa

Background: Type 2 diabetes (T2DM) accounts for over 90% of all diabetes cases globally. The rising prevalence of T2DM is driven by population ageing, economic development, urbanisation, sedentary lifestyles and greater consumption of unhealthy foods. Undiagnosed diabetes is common in many parts of Africa, including rural Nigeria, due to factors such as poor accessibility to health facilities, cultural barriers and high rates of health illiteracy. The cornerstone of T2DM management is promoting a lifestyle that includes a healthy diet, regular physical activity, smoking cessation and maintenance of a healthy body weight.

Purpose: The overall aim of this study was to determine the effectiveness of the Diabetes Self Management Education (DSME) programme among individuals with T2DM in Jigawa State, Nigeria.

Methods: A quantitative approach using a pre-test-post-test design was employed. One health centre was purposively selected for the implementation of DSME training programme. Consecutive sampling was utilised to determine a minimum sample size of 200 clients with T2DM (alpha level of 5% and power level of 90%). DSME addressed seven self-care behaviours essential for effective diabetes management, namely healthy eating, being active, monitoring, taking medication, problem solving, healthy coping and reducing risks. The programme was conducted over a period of eight weeks. Baseline outcome measures including resting blood pressure (BP), height, weight and random blood glucose (HGT)] were taken in the first week. Body mass Index (BMI) and waist-hip ratio were calculated for each participant. The valid and reliable Diabetes Self-Care Knowledge Scale (DSCK-30) and the Diabetes Care Profile was used to determine knowledge and self-efficacy respectively. The following seven weeks addressed each of the self-care behaviours in 2-hour sessions, implemented by the first author who is a trained Diabetes Educator. Sessions were conducted in groups with a maximum of twenty (20) participants per group. Descriptive statistics was applied to summarise socio-demographic information. Inferential statistics were employed to determine any association between variables. Statistical significance was set at p<0.05. One-way repeated measure ANOVA analyses was conducted to compare the effectiveness of DSME training on outcomes measures at baseline and post-intervention.

Results: The study sample consisted of 91 males (45.5%) and 109 females (54.5%) with a mean age of 47.95 (SD±13.20) years. A statistically significant decrease in weight, BMI, random HGT, Systolic BP and Diastolic BP (p<0.05) was found after 8 weeks. The eta statistic indicated high effect size for weight (0.36), BMI (0.83) and random HGT (0.49). Significant improvement was found in all three domains, namely modifiable lifestyles, adherence to self-care practices and consequences of uncontrolled blood sugar levels (p=0.0001) as well as in overall diabetic self-care knowledge (w=12.06, p=0.0001) post-intervention. Diabetes self-efficacy improved significantly post-intervention in eight of the nine domains (p<0.05), with the exception of the support domain (p>0.05).

Conclusions: The DSME intervention proved to be an effective treatment approach in optimising the healthcare behaviours, quality of life, as well as medication use among individuals with T2DM.

Implications: Socio-culturally appropriate diabetes education programmes are needed in addressing traditional perceptions and cultural opinions which impede appropriate prevention for T2DM and its risk factors.

Keywords:
DSME
effectiveness
T2DM

Topics:
Non-communicable diseases (NCDs) & risk factors
Primary health care
Education: clinical

Did this work require ethics approval? Yes

Institution: University of the Western Cape, South Africa

Committee: Senate Research Committee

Ethics number: (15/4/52)