Use of the socio-ecological model to explore factors that influence the implementation of a diabetes structured education programme (EXTEND project) inLilongwe, Malawi and Maputo, Mozambique: a qualitative study

C Bamuya,M J Davies,D Beran,Ana Magaia,A M Crampin,E M Brady,A Damasceno,M Hadjiconstantinou,Naomi Levitt,D Harrington,J C Correia

doi:10.1186/s12889-021-11338-y

Abstract

BackgroundDiabetes Self-Management Education and Support (DSMES) programmes are vital for type 2 diabetes mellitus (T2DM) management. However, they are limited in Sub-Saharan Africa (SSA). To address this gap, a DSMES, namedEXTEND was developed in Lilongwe (Malawi) and Maputo (Mozambique). This qualitative study aimed to explore factors that influence the implementation of DSMES in these settings.MethodsThe Socio-ecological model was applied to explore factors influencing the implementation of DSMES in SSA. Data was analysed using the Framework method and constant comparative techniques. Sixty-six people participated in the study: people with T2DM who participated in the EXTEND programme; healthcare professionals (HCPs), EXTEND educators, EXTEND trainers, and stakeholders.ResultsOur findings indicate that there is a need to develop an integrated and dedicated diabetes services in SSA healthcare systems, incorporating culturally adapted DSMES and tailored diabetes training to all professions involved in diabetes management. Traditional media and the involvement of community leaders were proposed as important elements to help engage and promote DSMES programmes in local communities. During the design and implementation of DSMES, it is important to consider individual and societal barriers to self-care.ConclusionFindings from this study suggest that multi-faceted factors play a significant role to the implementation of DSMES programmes in LICs. In the future, EXTEND could be incorporated in the development of diabetes training and dedicated diabetes services in SSA healthcare systems, acting as an educational tool for both people with T2DM and HCPs. This project was supported by the Medical Research Council GCRF NCDs Foundation Awards 2016 Development Pathway Funding.

Highlights

Diabetes Self-Management Education and Support (DSMES) programmes are vital for type 2 diabetes mellitus (T2DM) management
There is a need to develop an integrated and dedicated diabetes services in Sub-Saharan Africa (SSA) healthcare systems, incorporating culturally adapted DSMES and tailored diabetes training to all professions involved in diabetes management
Stakeholders consisted of representatives from the non-communicable disease (NCD) Department of the Mozambican Ministry of Health and the Eduardo Mondlane University of Mozambique; Healthcare Professionals (HCP) consisted of medical doctors, one internal medicine physician and one endocrinologist

Summary

Introduction

Diabetes Self-Management Education and Support (DSMES) programmes are vital for type 2 diabetes mellitus (T2DM) management. They are limited in Sub-Saharan Africa (SSA). To address this gap, a DSMES, namedEXTEND was developed in Lilongwe (Malawi) and Maputo (Mozambique). A DSMES, namedEXTEND was developed in Lilongwe (Malawi) and Maputo (Mozambique) This qualitative study aimed to explore factors that influence the implementation of DSMES in these settings. T2DM is fast becoming a prominent cause of high levels of morbidity and mortality in low-income countries (LICs) in sub-Saharan African (SSA) [3]. Issues around poor patient outcomes for diabetes are multi-facetted and are largely associated with five distinct domains that include individual (factors and or circumstances directly related to the person with diabetes such as their occupation, their health literacy, their existing co-morbidities etc.); interpersonal (the person with diabetes relationship(s) with spouse, carer, consultant, children etc.); community (the impact of the local community on the person with diabetes, i.e. access to green space, community groups/ activities); policymakers (those who decide what provisions should be prioritised for diabetes care or the person with diabetes) and commissioners (those who decide what provisions should be paid for/provided to diabetes care or the person with diabetes) [8, 9]

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