Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review protocol

Firima, Emmanuel; Fernández, Lucía; Huber, Jacqueline; Belus, Jennifer M.; Raeber, Fabian; Gupta, Ravi; Mokhohlane, Joalane; Mphunyane, Madavida; Amstutz, Alain; Labhardt, Niklaus Daniel

doi:10.12688/f1000research.52114.2

Cited by 4 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although community-based care has been considered an important add-on approach especially for patients with chronic diseases like diabetes, 4 8 32 such initiatives have not been well integrated in diabetes management in the SSA and most specifically in Uganda, thus the limited publications on their role. This study explored the roles of community-based health clubs in promoting health education for self-care management among patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Task-shifting of roles from physicians to nurses or lay cadres has for long been applied as an essential component of community-based care. 4 15 26 For example, task-shifting from health workers to peers has successfully been employed in the maternal and child health activities and in HIV/AIDS response for community care and has yielded positive results and patient clinical outcomes. 4 15 Therefore, in a resource-limited setting, the nurse educator’s (who is also a patient with diabetes) role would be shifted to being a ‘diabetes champion’, who has been trained to help educate and support fellow diabetics.…”

Section: Discussionmentioning

confidence: 99%

“…Type 2 diabetes arises from decreased insulin secretion or insulin resistance characterised by chronic hyperglycaemia, and this is associated with a wide range of long-term complications such as atherosclerosis, hypertension, coronary heart disease, peripheral neuropathy, diabetic foot syndrome, renal disease and retinopathy among others. 4 5 Despite the advances in the clinical management of DM, health systems in most parts of the world, especially in low-income and middle-income countries where patients cannot afford the cost of care associated with chronic diseases like DM, are still struggling to diagnose and manage DM. 3 6 Such patients suffer and many succumb to various complications that would otherwise be prevented or delayed with early diagnosis, proper clinical management and appropriate self-care.…”

Section: Introductionmentioning

confidence: 99%

“…Community-based health clubs have been suggested as a novel way of improving diabetes management especially in settings with uneven distribution of healthcare facilities and inaccessibility to healthcare services that limit patients’ awareness of the disease and self-care management. 4 26 Community-based clubs further provide an understanding of the socially specific and community-centric components of health and wellness as integral attributes to the holistic and long-term treatment and prevention of diabetes with associated complications and can contribute to eradication of self-care barriers and stigma of diabetes within the community-enhanced patient-centred outcomes, enable patient acceptability and ultimately lead to improved patient engagement and satisfaction. Community-based programmes mainly provide health behavioural interventions through a group-based approach and emphasise the localisation of care close to the patient’s residence rather than in a hospital or clinic.…”

Section: Introductionmentioning

confidence: 99%

“…Community-based programmes mainly provide health behavioural interventions through a group-based approach and emphasise the localisation of care close to the patient’s residence rather than in a hospital or clinic. 4 27 28 This interventional study was aimed at exploring the role of community-based health clubs in promoting patients’ health education for diabetes self-care management towards lifestyle modification, adherence to treatment, reduced risk factors, and improved dietary behaviours and glycaemic control among patients.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Role of community-based health clubs in promoting patients’ health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting

Lubega,

Ogwok,

Nabunya

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

BackgroundSelf-care management support is a core component of the Chronic Care Model that emphasises the need for empowering and preparing patients to manage their healthcare. In diabetes mellitus (DM) management, health education towards self-care empowers patients to make day-to-day decisions on their own disease and live with a healthy lifestyle. Although several strategies have been undertaken to improve the management of DM in Uganda, little has been done to empower patients to manage their own health. Community-based health clubs have been suggested as a novel way of improving diabetes management especially in settings with uneven distribution of healthcare facilities and inaccessibility to healthcare services that limit patients’ awareness of the disease and self-care management. This interventional study was aimed at exploring the role of community-based health clubs in promoting patients’ health education for diabetes self-care management.MethodsA cross-sectional qualitative study was conducted among 20 participants using focus group discussions with each having six to eight members. Only patients with diabetes who seek routine diabetes healthcare services at Wakiso Health Centre IV and had participated in the 8-week community-based health clubs’ health education sessions were recruited for the study. The audio-recordings were transcribed verbatim and translated into English; thematic data analysis was conducted to generate codes and themes. Similar codes were merged and a group consensus was reached on coding discrepancies.ResultsThree major themes on the role of health clubs in promoting patients’ health education were merged from the study. These include promoting sharing of experiences among patients, improving awareness of healthy self-care practices and offering sufficient patient–health worker interaction time.ConclusionsThis is the first publication reporting on the role of community-based health clubs in promoting patients’ health education towards diabetes self-care management in Uganda. The ability to share experiences among patients, improve patients’ awareness on healthy living practices and the increased health worker–patient interaction time contribute heavily to the capacity-building for self-care among patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Role of community-based health clubs in promoting patients’ health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting

Lubega,

Ogwok,

Nabunya

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

show abstract

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: A scoping review

Firima,

Gonzalez,

Ursprung

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Introduction The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes. Aim We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available. Methods We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was done, and comparisons made between community-based and facility-based models, where within-study comparison was reported. Results We retrieved 5,335 unique studies, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were only add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias. Conclusion Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.

show abstract

Establishment and health management application of a prediction model for high-risk complication combination of type 2 diabetes mellitus based on data mining

et al. 2023

View full text Add to dashboard Cite

In recent years, the prevalence of T2DM has been increasing annually, in particular, the personal and socioeconomic burden caused by multiple complications has become increasingly serious. This study aimed to screen out the high-risk complication combination of T2DM through various data mining methods, establish and evaluate a risk prediction model of the complication combination in patients with T2DM. Questionnaire surveys, physical examinations, and biochemical tests were conducted on 4,937 patients with T2DM, and 810 cases of sample data with complications were retained. The high-risk complication combination was screened by association rules based on the Apriori algorithm. Risk factors were screened using the LASSO regression model, random forest model, and support vector machine. A risk prediction model was established using logistic regression analysis, and a dynamic nomogram was constructed. Receiver operating characteristic (ROC) curves, harrell’s concordance index (C-Index), calibration curves, decision curve analysis (DCA), and internal validation were used to evaluate the differentiation, calibration, and clinical applicability of the models. This study found that patients with T2DM had a high-risk combination of lower extremity vasculopathy, diabetic foot, and diabetic retinopathy. Based on this, body mass index, diastolic blood pressure, total cholesterol, triglyceride, 2-hour postprandial blood glucose and blood urea nitrogen levels were screened and used for the modeling analysis. The area under the ROC curves of the internal and external validations were 0.768 (95% CI, 0.744−0.792) and 0.745 (95% CI, 0.669−0.820), respectively, and the C-index and AUC value were consistent. The calibration plots showed good calibration, and the risk threshold for DCA was 30–54%. In this study, we developed and evaluated a predictive model for the development of a high-risk complication combination while uncovering the pattern of complications in patients with T2DM. This model has a practical guiding effect on the health management of patients with T2DM in community settings.

show abstract

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review protocol

Cited by 4 publications

References 25 publications

Role of community-based health clubs in promoting patients’ health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting

Role of community-based health clubs in promoting patients’ health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: A scoping review

Establishment and health management application of a prediction model for high-risk complication combination of type 2 diabetes mellitus based on data mining

Contact Info

Product

Resources

About