A face-to-face peer support model for patients with type 2 diabetes
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Date
2020-07
Authors
Pienaar, Melanie
Journal Title
Journal ISSN
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Publisher
University of the Free State
Abstract
Background: Prevalence of Type 2 diabetes has reached pandemic proportions globally. New and effective ways are needed to improve diabetes self-management. However, many barriers to self-management exist, such as lack of support, lack of resources, geographical constraints and lack of knowledge, which may be fuelling the increase of Type 2 diabetes. Face-to-face peer support may have the potential to improve self-management in Type 2 diabetes. Purpose: The purpose of the study was to establish the feasibility of a face-to-face peer support model for patients with Type 2 diabetes in a sub-district in the Free State province of South Africa. Methods: Multiple research methods, guided by the integrated model of behaviour prediction, were used to establish the feasibility of a developed face-to-face peer support model developed for patients with Type 2 diabetes. In the first stage of the study, a systematic review, guided by the steps of the Cochrane Collaboration (2006), was conducted to critically synthesise the best available evidence on face-to-face peer support models for adults with Type 2 diabetes in low and middle-income countries. Multiple data sources were consulted for the period January 2000 to December 2017. Screening and selection of papers followed, as well as critical appraisal and data extraction, by at least two reviewers and, finally, narrative synthesis was done. The synthesised data of the systematic review informed the pilot of the face-to-face peer support model. The second stage of the study established the impact of the implemented face-to-face peer support intervention on adults with Type 2 diabetes in South Africa. A cluster randomised control trial was conducted involving adults with Type 2 diabetes from six communities in a semi-urban rural area in the Free State province. Three communities were randomly allocated to the intervention group and three to the control group. Trained community health workers provided monthly group sessions and home visits to the intervention group. The control group received their usual care. The primary outcome of the study was taken as glycated haemoglobin measured by the BioHermes Automatic Glycohemglobin Analyzer; secondary outcomes were blood pressure, waist circumference and body mass index. Outcomes were assessed at baseline and after four months. Descriptive statistics was determined per group. The last stage of the study determined the experiences of the patients with Type 2 diabetes who took part in the face-to-face peer support intervention. Sesotho-speaking women who participated in the face-to-face peer support intervention were purposively sampled, and took part in this visual-based narrative inquiry. Textual and visual data was collected using the Mmogo-method® and data was analysed thematically. Results: In the systematic review, Stage 1 of the study, two common models of face-to-face peer support were identified for low and middle-income countries, namely, diabetic patients and community health workers. Essential components were highlighted for the planning and implementation of these models, such as recruitment, selection, training and supervision of peer supporters, as well as the nature of the peer intervention. The cluster randomised controlled trial study, Stage 2 of the study, resulted in a significant improvement in diastolic blood pressure of individuals (P=0.02) in the intervention group. No differences were, however, found from baseline between groups regarding the variables glycated haemoglobin (P=0.87), systolic blood pressure (P=0.13), body mass index (P=0.21) and waist circumference (P=0.24). The Mmogo-method®, Stage 3 of the study, showed that the participants valued the face-to-face peer support intervention and acknowledged community health workers as an important source of support to them. Participants expressed that the intervention helped them to make positive lifestyle changes, and because they were exposed to the support continuously, their confidence in the self-management of diabetes improved. Conclusions: The study demonstrated that, despite modest results, a face-to-face peer support model for patients with Type 2 diabetes that involves community health workers is feasible and valuable in low and middle-income countries like South Africa.
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Keywords
Thesis (Ph.D. (Nursing))--University of the Free State, 2020, Type 2 diabetes, Peer support, Self-management, Low and middle-income countries, Community health workers