Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa

Mathose, Tasunungurwa T; Mash, Robert

doi:10.4102/safp.v65i1.5656

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…42 There may be a need to develop further content, for example, to assist people with initiating insulin. 43…”

Section: Discussionmentioning

confidence: 99%

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

Mash,

Schouw

2024

BMJ Open

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ObjectiveType 2 diabetes is a leading contributor to the burden of disease in South Africa. Primary care is struggling to support self-management and lifestyle change. Group empowerment and training (GREAT) for diabetes is a feasible and cost-effective intervention in our setting. This study aimed to evaluate the implementation of GREAT for diabetes.DesignA convergent mixed-methods study evaluated a range of implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, reach and cost.SettingTen primary care facilities from a district in all nine provinces of South Africa.ParticipantsDescriptive exploratory individual semistructured interviews were conducted with 34 key stakeholders from national policy-makers to primary care providers. Three focus group interviews were held with 35 patients.ResultsThe National Department of Health saw GREAT as an acceptable and appropriate intervention, but only five of the nine provinces adopted GREAT. District-level and facility-level managers also saw GREAT as an acceptable and appropriate intervention. Factors related to feasibility included physical space, sufficient staff numbers, availability of resource materials, the health information system, adaptation to the model of care (selection of facilities, patients, adjustment of patient flow and appointment systems, leadership from local managers and the whole clinical team) and inclusion in systems for quality improvement. No major changes were made to the design of GREAT and fidelity to the session content ranged from 66% to 94%. Incremental costs were US$494 per facility. Due to disruption from the COVID-19 pandemic, only 14 facilities implemented and reached 588 patients at the time of evaluation.ConclusionKey lessons were learnt on how to implement GREAT for diabetes in a middle-income country setting. The findings informed the design of a programme theory using a health system framework. The programme theory will guide further scale-up in each province and scale-out to provinces that have not yet implemented.QuestionThis study focused on evaluating how to implement GREAT for type 2 diabetes in primary care and to take it to scale in South Africa.FindingThe findings led to a programme theory on how to successfully implement GREAT for diabetes in the South African context.MeaningThe study demonstrates relevant contextual factors that need to be considered in the implementation of group diabetes education programme in a middle-income country.

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“…42 There may be a need to develop further content, for example, to assist people with initiating insulin. 43…”

Section: Discussionmentioning

confidence: 99%

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

Mash,

Schouw

2024

BMJ Open

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“…This is another roadblock on the journey to better control and a recent study highlighted many of the factors involved. 25 This study also recommended that a similar group process be developed and evaluated for people that need to start insulin. This would follow similar principles to GREAT for diabetes and run over three sessions.…”

Section: Discussionmentioning

confidence: 99%

The sustainability of group empowerment and training for people with diabetes in South Africa

Mash,

Schouw

2024

South African Family Practice

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Background: Group empowerment and training (GREAT) for people with type 2 diabetes enables self-management and lifestyle modification. GREAT for diabetes was implemented in primary care facilities in five South African provinces in the beginning of 2022. The aim was to evaluate implementation and to particularly explore factors that influenced the sustainability of implementation.Methods: An exploratory, descriptive qualitative study conducted semi-structured individual interviews with 17 key stakeholders at the end of 2023. Interviews explored factors within a theory of change framework derived from an initial evaluation in 2022. Data were analysed using the framework method and ATLAS.ti.Results: Implementation and scale-up was sustained in the Western Cape. Governance and financing at a provincial and district level were key to health system structures. Space, staffing, resource materials and monitoring of implementation were key to the inputs. Facility managers, training and performance of facilitators, including the whole team, selecting patients, patient flow and appointments, stakeholder support and clinical governance were key to service delivery. Facilities that had implemented, reported reaching 300 patients per year. A range of motivational, behavioural and clinical outcomes were reported. Future implementation could include community health workers and group empowerment for insulin initiation.Conclusion: Implementation and scale-up was only sustained in one province and a range of factors related to sustained implementation were identified.Contribution: The factors identified can guide the successful implementation and scale-up of GREAT for diabetes in South Africa.

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Patient’s barrier to initiate insulin therapy for type 2 D.M.

Salih,

Al-Dewachi,

Yassen

et al. 2024

Ir J Med Sci

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Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa

Cited by 4 publications

References 29 publications

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

The sustainability of group empowerment and training for people with diabetes in South Africa

Patient’s barrier to initiate insulin therapy for type 2 D.M.

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