An Audit of Diabetes Self-Management Education Programs in South Africa

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 healthDiabetes 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.

Self-Management Support Needs of Patients with Chronic Diseases in a South African Township: A Qualitative Study

“…Patient health education is haphazard and may result in conflicting or confusing messages received from different providers. Other South African studies report on the lack of training of primary healthcare providers in behavior-change counselling skills and recommend effective training, accompanied by health-system reform that supports health promotion and self-management (Dube et al, 2015a;Malan, Mash, & Everett-Murphy, 2015;Murphy, Chuma, Mathews, Steyn, & Levitt, 2015).…”

“…They are conditions that do not disappear, and affected people have to adjust their lifestyles to remain healthy (van Olmen et al, 2011). As such, self-management is generally considered a key treatment modality for patients with chronic diseases (Dube et al, 2015a). review demonstrating the effectiveness of self-management interventions implemented by PHC nurses (Sargent, Forrest, & Parker, 2012).…”

Experiences of Clinic Nurses Regarding Diabetes Education in Turkey’ Health System

“…Studies stated that the first three subjects of education given to the patient with type 2 diabetes include the definition of diabetes and its complications, healthy diet, and physical activity [22,23].…”

The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe

“…1,9 Most of these data originate from North America and Europe, and very little is documented concerning the impact of DSME led by both types of health professionals in sub-Saharan Africa. 8,10 A major contributor to the lack of evidence to support specialist DSME interventions in Africa is the severe shortage of registered dietitians and diabetes educators, particularly in public health facilities. According to the health professionals' council, Zimbabwe has under 20 registered dietitians in practice and only two of them are stationed at the two tertiary hospitals in Harare.…”

“…Evidence on DSME in Africa also shows that DSME in lowresource settings is not consistent in structure, and outcomes thereof are not routinely monitored or measured. 8,10 Therefore, there is paucity of information on the outcomes of existing DSME interventions. This study assessed the impact of existing interventions in outpatient diabetes clinics by comparing patient knowledge, attitudes and practices related to nutrition and other self-management parameters between patients who have received DSME compared with those who had not.…”