IDF21-0155 Effectiveness of a nurse-led community-based self-management program among adults with diabetes-family dyads in Ethiopia

Background: The management of diabetes in Africa is suboptimal and being challenged with a lack of understanding about local foods, misconceptions, lack of family support, and a poor health care system. Diabetes self-management practice is believed as the strategy for improving glycaemic control and family support is the backbone of implementing the self-management. However, culturally sensitive, community-based diabetes self-management education and support (DSMES) among the Ethiopian diabetic population is unknown. Aim: To examine the preliminary effects of a nurse-led community-based DSMES program on diabetes self-management behavior and family support behavior. Method: A systematic review and meta-analysis were conducted to develop the intervention appropriate for patients living in Africa. A DSEMS program, guided by the social cognitive theory, was developed which comprised a brief introduction about diabetes, misconceptions, healthy eating, being active, medication, self-monitoring of blood glucose, risk reduction, healthy coping, and problem-solving to promote diabetic control for Ethiopian adults with type 2 diabetes. Afterward, a pretest-posttest 2-arm parallel-group pilot randomized controlled trial involving adults with type 2 diabetes was conducted to examine the preliminary effects of the DSMES program on diabetes self-management and family support behaviors. The trial protocol of this study was published elsewhere. The self-management behavior was assessed using the summary of diabetes self-care activities and the family support behavior was measured using the diabetes family behavior checklist. These tools were culturally adapted and tested for psychometric properties in Afaan Oromoo (a target and local language). A convenience sampling was used to select 76 adults with type 2 diabetes were recruited in the pilot RCT, with 38 participants randomly allocated to the intervention arm receiving six sessions of the DSMES program was supported by an educational handbook, fliers, and video on top of usual care and control arm continued the usual care. Recruitment of subjects was conducted at Nekemte Specialized Hospital, Ethiopia for two months. The intervention was delivered in the community of Nekemte city, Ethiopia by nurses. Descriptive statistics were applied to analyze the sociodemographic characteristics and mean score of the SDSCA and family support. Intention to treat analysis was applied for missing data and independent samples t-tests were used to examine the effect of the intervention on these outcomes. Results: Seventy-three dyads participated in the intervention and post-intervention assessment. At baseline, self-management practice was 3.37 (SD±0.99); whereas at post-intervention 3.93 (SD±0.95) days per week. There was a statistically significant difference between the intervention and control groups (t=5.72, p<0.001). The mean of baseline family support was 43.80 (SD±9.62) with higher support provided among families in the intervention while the postintervention score was 54.20 (SD±0.11.92). There was a significant difference between the intervention and control groups (t=8.01, p<0.001). Discussion: The social cognitive theory-guided DSMES intervention is effective to improve self-management practice and family support among adults with diabetes-family dyads in Ethiopia which is inconsistent with other studies. Thus, a community-based DSMES intervention focusing on misconceptions, culturally sensitive foods, and engagement of families in intervention might be the strategy to improve their self-management practice and family support.