Diabetes Self-Management Education (DSME) – Effect on Knowledge, Self-Care Behavior, and Self-Efficacy Among Type 2 Diabetes Patients in Ethiopia: A Controlled Clinical Trial

Abstract

Purpose

Diabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients’ self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy.

Patients and methods

A before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups.

Results

At the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy.

Conclusion

Our study found significant improvements in the intervention participants’ diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia.

Trial registration

ClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.

Keywords:

• nurse-led DSME
• diabetes knowledge
• self-care behavior
• self-efficacy

Acknowledgments

We thank the study participants for participating in the DSME intervention, for their commitment to providing information, and for remaining in the study until its conclusion. We additionally extend our gratitude to the DSME providers and data collectors for their immense contribution. Lastly, we acknowledge the principal investigators of the SACCADE project (Prof. H. Amelak and Dr. Magnus, PIs) for supporting and funding this study under the NORHED program for capacity-building.

Abbreviations

CONSORT, Consolidated Standards of Reporting Trials; DKS, Diabetes Knowledge Scale; DSME, diabetes self-management education; HbA1c, glycated hemoglobin; JUMC, Jimma University Medical Centre; NORHED, The Norwegian Programme for Capacity Development in Higher Education and Research for Development; OHAs, oral hypoglycemic agents; REK, Norwegian Regional Committee for Medical and Health Research Ethics; SACCADE, Strategic and Collaborative Capacity Development in Ethiopia and Africa; SDSCA, Summary of Diabetes Self-Care Activities; SMS, short message service; SMRC, Self-Management Resource Centre; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.

Ethical Approval and Consent to Participate

“This study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.” Prior to the commencement of the study, ethical approval to conduct the study was secured from REK (Norwegian Regional Committee for Medical and Health Research Ethics) and the Jimma University Ethical Review Board. Moreover, at the recruitment stage, written informed consent was sought from each study participant, through an explanation of the study’s objective, the means of how and the reasons why they were selected for possible participation in the study, and an overview of the intervention.

Availability of Data and Materials

The datasets used and/or analyzed in the current study and the study protocols are available from the corresponding author upon reasonable request.

Author Contributions

All authors contributed to proposal development, the study design data analysis, and the drafting and revising of the article; provided final approval for the version that will be published; and agreed to be accountable for all aspects of the work.

Disclosure

Mr Fikadu Balcha Hailu report grants from Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED), during the conduct of the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research project was funded by the Strategic and Collaborative Capacity Development in Ethiopia and Africa (SACCADE) project, funded under the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED) under the NORHED Programme, Agreement No. ETH-13/0024. The funding body had no role in the design of the study; the collection, analysis, or interpretation of data; or in writing this manuscript.