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

Abstract

Introduction: Diabetes self-management education (DSME) and medical nutrition therapy (MNT), provided by diabetes educators and registered dietitians respectively, considerably improve glycaemic control. However, it is unknown what interventions exist in many African countries and the impact thereof. Aim: To determine the impact of existing DSME interventions on knowledge, attitudes and practices (KAP) of adults with type 2 diabetes attending public health care facilities in Harare, Zimbabwe. Methods: A cross-sectional, researcher-administered survey was designed to assess DSME KAP at eight outpatient diabetes clinics that provide diabetes services. Participants were conveniently sampled. Associations between mean scores for knowledge, attitudes and practices were compared between characteristics of DSME interventions. Results: A total of 154 participants were recruited and divided evenly between two tertiary (n = 77) and six primary outpatient clinics (n = 77). The mean age was 61.8 years (SD ± 12.7), mean years since diagnosis with diabetes was 8.1 years (SD ± 8.3) and the majority were females (66.9%, n = 103). Most participants (90.3%, n = 139) reported receiving some DSME. Participants most frequently cited a tertiary clinic as the place where DSME was received. Fewer had consulted a dietitian (49.0%, n = 76) or diabetes educator (52.0%, n = 80). Higher levels of diabetes knowledge were observed for tertiary clinic attendees (p = 0.00), consultation with a dietitian (p < 0.01) and diabetes educator (p = 0.00). Only those who had consulted a dietitian reported better adherence to dietary guidelines (p = 0.00) and physical activity (p = 0.02) self-care behaviours. Conclusion: Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur.

Currents Nutritional Practices of Nutritionists in the Management of Type 2 Diabetes Patients at Public Health Centres in Padang, Indonesia

“…In Zimbabwe, dietitians and nutritionists need to fulfill 1200 clinical hours and be registered with the Allied Health Practitioners Council of Zimbabwe before they can practice in the clinical setting. Furthermore, they should constantly keep themselves updated with the latest developments in their field [10]. The New Zealand (NZ) Primary Healthcare Centres found similar barriers in the patients' management of DM even though NZ requires a dietitian to have specific qualification with varying degrees of experience and be registered with the Dietitians Board of NZ [11,18].…”

“…A cross-sectional study in 2019 reported that the number of T2DM patients that received nutrition education based on the attendance records from the previous year ranged from 4 to 19 at six selected clinics across nine health districts. The average number of T2DM patients seen by the diabetes educator were eight patients per week, or 32 cases per month [10]. The low number of patients could be related to the lack of interest of their preference to consult a doctor.…”

“…Similar to Indonesia, dietitians in Zimbabwe needed 30 to 60 min to conduct one-on-one or group nutrition education counselling. Meanwhile, dietitians in Australia and NZ generally spend 30 to 90 min for one-on-one, routine medical consultations and patient-centered diabetes care [8][9][10][11]. Accredited Practicing Dietitians (APDs) invited individuals with T2DM at least twice a week to nutrition education sessions via an advertisement posted in their electronic newsletter [8].…”

“…To date, many studies have reported on the roles and practices of dietitians or nutritionists in the management of diabetes [8][9][10]. Generally, all studies agreed that nutrition counselling is crucial in modifying eating habits, nutritional knowledge, and food preparation skills among individuals with T2DM [8][9][10]. However, there is a variation in the underlying adequacy and characteristics of nutrition services.…”

“…Recently, the interest in nutrition practices and education provided by Indonesian nutritionists is emerging. Although the Indonesian Department of Health has produced clinical practices guidelines to guide the medical treatment and management of T2DM, information about nutrition education remains minimal [9,10]. Therefore, this study aimed to determine the nutrition practices of among the nutritionists and the adequacy of the current practices in the management of T2DM at the PHC.…”