An evaluation of health promoters' adherence to a planned diabetes educational intervention that includes motivational interviewing at community health centres in Cape Town

Includes abstract.Includes bibliographical references

The ability of health promoters to deliver group diabetes education in South African primary care

CITATION: Botes, A. S., Majikela- Dlangamandla, B. & Mash, R. 2013. The ability of health promoters to deliver group diabetes education in South African primary care. African Journal of Primary Health Care & Family Medicine, 5(1): 1-8, doi: 10.4102/phcfm.v5i1.484.The original publication is available at http://www.phcfm.orgENGLISH SUMMARY : Background: Diabetes makes a significant contribution to the burden of disease in South Africa. This study assesses a group diabetes education programme using motivational interviewing in public sector health centres serving low socio-economic communities in Cape Town. The programme was delivered by mid-level health promotion officers (HPOs). Objectives: The aim of the study was to explore the experience of the HPOs and to observe their fidelity to the educational programme. Methods: Three focus group interviews were held with the 14 HPOs who delivered the educational programme in 17 health centres. Thirty-three sessions were observed directly and the audio tapes were analysed using the motivational interviewing (MI) integrity code. Results: The HPOs felt confident in their ability to deliver group education after receiving the training. They reported a significant shift in their communication style and skills. They felt the new approach was feasible and better than before. The resource material was found to be relevant, understandable and useful. The HPOs struggled with poor patient attendance and a lack of suitable space at the facilities. They delivered the majority of the content and achieved beginning-level proficiency in the MI guiding style of communication and the use of open questions. The HPOs did not demonstrate proficiency in active listening and continued to offer some unsolicited advice. Conclusion: The HPOs demonstrated their potential to deliver group diabetes education despite issues that should be addressed in future training and the district health services. The findings will help with the interpretation of results from a randomised controlled trial evaluating the effectiveness of the education.SOMMAIRE FRANÇAIS : La capacité des promoteurs de la santé pour offrir une éducation au diabète groupe dans le sud de soins primaires africaine Présentation: Le diabète contribue dans une large mesure à la charge de morbidité en Afrique du Sud. Cette étude évalue un programme d’éducation de groupe sur le diabète en utilisant la méthode de l’entretien motivationnel dans des centres de santé du secteur public desservant les communautés socio-économiques désavantagées du Cap. Le programme a été dispense par des agents de promotion de la santé (APS) de niveau intermédiaire. Objectifs: L’objectif de l’étude était d’étudier l’expérience des APS et d’observer la mesure dans laquelle ils restaient fidèles au programme d’éducation. Méthode: Trois sessions de groupe de discussion ont été organisées avec les 14 APS dispensant le programme d’éducation dans 17 centres de santé. Trente-trois sessions ont directement été observées et les bandes audio ont été analysées en utilisant le code d’intégrité relatif à l’entretien motivationnel (EM). Résultats: Les APS avaient confiance en leur capacité à prodiguer un enseignement à des groupes après avoir suivi la formation. Ils ont observé un changement significatif dans le style et leurs compétences de communication. Ils avaient le sentiment que la nouvelle approche était exploitable et meilleure que la précédente. Les ressources fournies étaient pertinentes, compréhensibles et utiles. Les APS trouvaient que la faible participation des patients et l’absence d’espace adéquat dans les locaux leur rendaient la tâche plus difficile. La majeure partie du contenu était communiquée et ils ont pu atteindre le niveau de débutant en style de communication de l’EM et dans l’utilisation de questions ouvertes. Les APS ne disposaient pas encore d’excellentes compétences d’écoute active et continuaient à fournir des conseils non sollicités. Conclusion: Les APS ont démontré qu’ils étaient capables de prodiguer un enseignement sur le diabète à des groupes, en dépit de problèmes qui devront être traités au cours de futures formations et dans les services de santé de quartier. Les conclusions contribueront à l’interprétation des résultats obtenus à partir d’un essai contrôlé et aléatoire évaluant l’efficacité de l’enseignement.http://www.phcfm.org/index.php/phcfm/article/view/484Publisher's versio

‘I accept his manhood is on life-support’: a qualitative understanding of the impact of diabetes on sexual relationships among men and women living with type 2 diabetes and their partners in South Africa

Aim: to explore the impact of diabetes on sexual relationships among men and women living with Type 2 diabetes (PLWD) and their partners in Cape Town, South Africa.Methods: as part of a larger study developing an intervention to improve type 2 diabetes mellitus (T2DM) self-management, we conducted in-depth individual interviews with ten PLWD and their partners without diabetes about experiences living with T2DM, between July 2020 and January 2021. We used inductive thematic analysis.Results: both PLWD and partners felt that their sexual relationships and desires changed post-diagnosis, in ways beyond biomedical issues. Although couples’ reports on the quality of their sexual relationships were concordant, most participants had not communicated their sexual desires and concerns with each other, causing unhappiness and fears of disappointing or losing their partner. Participants felt uninformed about sexual dysfunction but had not discussed this with their health care provider, leading to increased anxiety.Conclusion: PLWD and their partners need more informational support to increase their understanding of diabetes associated sexual dysfunction and to decrease fears and anxiety. Strengthening communication within couples on sexual issues may empower them to find solutions to problems experienced. This may improve couples’ relationships and quality of life, and indirectly result in better self-management of T2DM

Intervention development of ‘Diabetes Together’ using the person-based approach: a couples-focused intervention to support self-management of type 2 diabetes in South Africa

Objectives Type 2 diabetes (T2D) is a growing concern in South Africa, where many find self-management challenging. Behaviour-change health interventions are enhanced by involving partners of patients. We aimed to develop a couples-focused intervention to improve self-management of T2D among adults in South Africa.Design We used the person-based approach (PBA): synthesising evidence from existing interventions; background research; theory; and primary qualitative interviews with 10 couples to ascertain barriers and facilitators to self-management. This evidence was used to formulate guiding principles that directed the intervention design. We then prototyped the intervention workshop material, shared it with our public and patient involvement group and ran iterative co-discovery think-aloud sessions with nine couples. Feedback was rapidly analysed and changes formulated to improve the intervention, optimising its acceptability and maximising its potential efficacy.Setting We recruited couples using public-sector health services in the area of Cape Town, South Africa, during 2020–2021.Participants The 38 participants were couples where one person had T2D.Intervention We developed the ‘Diabetes Together’ intervention to support self-management of T2D among couples in South Africa, focussing on: improved communication and shared appraisal of T2D; identifying opportunities for better self-management; and support from partners. Diabetes Together combined eight informational and two skills-building sections over two workshops.Results Our guiding principles included: providing equal information on T2D to partners; improving couples’ communication; shared goal-setting; discussion of diabetes fears; discussing couples’ roles in diabetes self-management; and supporting couples’ autonomy to identify and prioritise diabetes self-management strategies.Participants viewing Diabetes Together valued the couples-focus of the intervention, especially communication. Feedback resulted in several improvements throughout the intervention, for example, addressing health concerns and tailoring to the setting.Conclusions Using the PBA, our intervention was developed and tailored to our target audience. Our next step is to pilot the workshops’ feasibility and acceptability

Intervention development of ‘Diabetes Together’ using the person-based approach: a couples-focused intervention to support self-management of type 2 diabetes in South Africa

Objectives: Type 2 diabetes (T2D) is a growing concern in South Africa, where many find self-management challenging. Behaviour-change health interventions are enhanced by involving partners of patients. We aimed to develop a couples-focused intervention to improve self-management of T2D among adults in South Africa.Design: We used the person-based approach (PBA): synthesising evidence from existing interventions; background research; theory; and primary qualitative interviews with 10 couples to ascertain barriers and facilitators to self-management. This evidence was used to formulate guiding principles that directed the intervention design. We then prototyped the intervention workshop material, shared it with our public and patient involvement group and ran iterative co-discovery think-aloud sessions with nine couples. Feedback was rapidly analysed and changes formulated to improve the intervention, optimising its acceptability and maximising its potential efficacy.Setting: We recruited couples using public-sector health services in the area of Cape Town, South Africa, during 2020-2021.Participants: The 38 participants were couples where one person had T2D.Intervention: We developed the 'Diabetes Together' intervention to support self-management of T2D among couples in South Africa, focussing on: improved communication and shared appraisal of T2D; identifying opportunities for better self-management; and support from partners. Diabetes Together combined eight informational and two skills-building sections over two workshops.Results: Our guiding principles included: providing equal information on T2D to partners; improving couples' communication; shared goal-setting; discussion of diabetes fears; discussing couples' roles in diabetes self-management; and supporting couples' autonomy to identify and prioritise diabetes self-management strategies.Participants viewing Diabetes Together valued the couples-focus of the intervention, especially communication. Feedback resulted in several improvements throughout the intervention, for example, addressing health concerns and tailoring to the setting.Conclusions: Using the PBA, our intervention was developed and tailored to our target audience. Our next step is to pilot the workshops' feasibility and acceptability