Effectiveness of a group diabetes education programme in underserved communities in South Africa : pragmatic cluster randomized control trial
Date
2012-12
Authors
Mash, Bob
Levitt, Naomi
Steyn, Krisela
Zwarenstein, Merrick
Rollnick, Stephen
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33% have been recorded in Cape Town. Previous studies show that quality of care and health outcomes are poor. The development of an effective education programme should impact on self-care, lifestyle change and adherence to medication; and lead to better control of diabetes, fewer complications and better quality of life.
Methods: Trial design: Pragmatic cluster randomized controlled trial
Participants: Type 2 diabetic patients attending 45 public sector community health centres in Cape Town
Interventions: The intervention group will receive 4 sessions of group diabetes education delivered by a health promotion officer in a guiding style. The control group will receive usual care which consists of ad hoc advice during consultations and occasional educational talks in the waiting room.
Objective: To evaluate the effectiveness of the group diabetes education programme
Outcomes: Primary outcomes: diabetes self-care activities, 5% weight loss, 1% reduction in HbA1c. Secondary
outcomes: self-efficacy, locus of control, mean blood pressure, mean weight loss, mean waist circumference, mean HbA1c, mean total cholesterol, quality of life
Randomisation: Computer generated random numbers
Blinding: Patients, health promoters and research assistants could not be blinded to the health centre’s allocation
Numbers randomized: Seventeen health centres (34 in total) will be randomly assigned to either control or
intervention groups. A sample size of 1360 patients in 34 clusters of 40 patients will give a power of 80% to detect the primary outcomes with 5% precision. Altogether 720 patients were recruited in the intervention arm and 850 in the control arm giving a total of 1570.
Discussion: The study will inform policy makers and managers of the district health system, particularly in low to middle income countries, if this programme can be implemented more widely.
Trial register: Pan African Clinical Trial Registry PACTR201205000380384
Description
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://www.biomedcentral.com/bmcfampract/
Bibliography
The original publication is available at http://www.biomedcentral.com/bmcfampract/
Bibliography
Keywords
Non-insulin-dependent diabetes -- South Africa, Group education -- South Africa, Diabetics -- Health and hygiene -- Education -- South Africa, Diabetics -- Health and hygiene -- South Africa, Community health programmes -- South Africa -- Cape Town, Lifestyles -- Health aspects, Diabetes -- Education -- Programmes -- South Africa -- Cape Town
Citation
Mash, B. et al. 2012. Effectiveness of a group diabetes education programme in underserved communities in South Africa: pragmatic cluster randomized control trial. BMC Family Practice, 13(126):1-7,
doi:10.1186/1471-2296-13-126.