Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach

Abstract

Background: Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. Meta Salud Diabetes (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups—grupos de ayuda mutua (GAMs) located within health centers.Methods: From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process.Results: All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding.Conclusion: Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico.Clinical Trial Registration:www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&draw=2&rank=1, identifier: NCT02804698.

Role of secreted frizzled-related protein 4 in prediabetes and type 2 diabetes: a cross sectional study

“…In Mexico, diabetes is the second leading cause of death and the leading cause of years of healthy life lost; for these reasons, in 2016, diabetes was declared an epidemiological emergency in Mexico by the National Health System [ 2 ]. It is well known that the defects in glucose metabolism that trigger T2D begin many years before the diagnosis of the disease [ 3 , 4 ].…”

Recent Findings on the Effectiveness of Peer Support for Patients with Type 2 Diabetes

“…Type 2 diabetes (T2DM) accounts for more than 90% of diabetes cases. Increasing rates are driven by socio-economic, demographic, environmental, and genetic factors [3]. Much of diabetes care needs to be carried out by patients, including monitoring blood glucose, taking medication, getting regular physical activity and maintaining a healthy diet [4••, 5].…”

Barreras y facilitadores para una alimentación saludable entre participantes de Meta Salud Diabetes en Sonora, México

“…Los resultados principales del proyecto han sido publicados previamente y mostraron que MSD contribuyó a reducir el riesgo cardiovascular y a mejorar el bienestar emocional de pacientes con diabetes que participan en los GAM (Aceves et al, 2021b;Rosales et al, 2021). También mostraron que el programa puede ser implementado como parte de la oferta de servicios de prevención de la Secretaría de Salud (Aceves et al, 2021a;Ingram et al, 2019;Velázquez-González, Castro-Vásquez, Cornejo-Vucovich y Denman, 2020).…”