PMID- 34238258
OWN - NLM
STAT- MEDLINE
DCOM- 20210805
LR  - 20240402
IS  - 1471-2458 (Electronic)
IS  - 1471-2458 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Jul 8
TI  - Use of the socio-ecological model to explore factors that influence the 
      implementation of a diabetes structured education programme (EXTEND project) 
      inLilongwe, Malawi and Maputo, Mozambique: a qualitative study.
PG  - 1355
LID - 10.1186/s12889-021-11338-y [doi]
LID - 1355
AB  - BACKGROUND: Diabetes Self-Management Education and Support (DSMES) programmes are 
      vital for type 2 diabetes mellitus (T2DM) management. However, they are limited 
      in Sub-Saharan Africa (SSA). To address this gap, a DSMES, namedEXTEND was 
      developed in Lilongwe (Malawi) and Maputo (Mozambique). This qualitative study 
      aimed to explore factors that influence the implementation of DSMES in these 
      settings. METHODS: The Socio-ecological model was applied to explore factors 
      influencing the implementation of DSMES in SSA. Data was analysed using the 
      Framework method and constant comparative techniques. Sixty-six people 
      participated in the study: people with T2DM who participated in the EXTEND 
      programme; healthcare professionals (HCPs), EXTEND educators, EXTEND trainers, 
      and stakeholders. RESULTS: Our findings indicate that there is a need to develop 
      an integrated and dedicated diabetes services in SSA healthcare systems, 
      incorporating culturally adapted DSMES and tailored diabetes training to all 
      professions involved in diabetes management. Traditional media and the 
      involvement of community leaders were proposed as important elements to help 
      engage and promote DSMES programmes in local communities. During the design and 
      implementation of DSMES, it is important to consider individual and societal 
      barriers to self-care. CONCLUSION: Findings from this study suggest that 
      multi-faceted factors play a significant role to the implementation of DSMES 
      programmes in LICs. In the future, EXTEND could be incorporated in the 
      development of diabetes training and dedicated diabetes services in SSA 
      healthcare systems, acting as an educational tool for both people with T2DM and 
      HCPs. This project was supported by the Medical Research Council GCRF NCDs 
      Foundation Awards 2016 Development Pathway Funding.
FAU - Bamuya, C
AU  - Bamuya C
AD  - Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
FAU - Correia, J C
AU  - Correia JC
AD  - Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and 
      Patient Education, WHO Collaborating Center, Department of Medicine, University 
      of Geneva and Geneva University Hospitals, Geneva, Switzerland.
FAU - Brady, E M
AU  - Brady EM
AD  - University Hospitals of Leicester NHS Trust, Leicester Diabetes Centre, 
      Leicester, UK.
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
FAU - Beran, D
AU  - Beran D
AD  - Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University 
      of Geneva and Geneva University Hospitals, Geneva, Switzerland.
FAU - Harrington, D
AU  - Harrington D
AD  - Diabetes Research Centre, College of Life Sciences, University of Leicester, 
      Leicester, UK.
AD  - Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland.
FAU - Damasceno, A
AU  - Damasceno A
AD  - Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
FAU - Crampin, A M
AU  - Crampin AM
AD  - Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
FAU - Magaia, Ana
AU  - Magaia A
AD  - Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
FAU - Levitt, Naomi
AU  - Levitt N
AD  - The University of Cape Town, Cape Town, South Africa.
FAU - Davies, M J
AU  - Davies MJ
AD  - Diabetes Research Centre, College of Life Sciences, University of Leicester, 
      Leicester, UK.
FAU - Hadjiconstantinou, M
AU  - Hadjiconstantinou M
AD  - Diabetes Research Centre, College of Life Sciences, University of Leicester, 
      Leicester, UK. mh333@le.ac.uk.
LA  - eng
GR  - MR/P02548X/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210708
PL  - England
TA  - BMC Public Health
JT  - BMC public health
JID - 100968562
SB  - IM
MH  - *Diabetes Mellitus, Type 2/epidemiology/therapy
MH  - Humans
MH  - Malawi/epidemiology
MH  - Mozambique/epidemiology
MH  - Qualitative Research
MH  - *Self-Management
PMC - PMC8268266
COIS- CB, JCC, EB, DB, AD, AM, AMC, NL and MH declare no conflict of interest. MJD 
      reports grants from University of Leicester, International Research Development 
      Fund during the conduct of the study. DH reports non-financial support (travel) 
      from Novo Nordisk UK, outside the submitted work.
EDAT- 2021/07/10 06:00
MHDA- 2021/08/06 06:00
PMCR- 2021/07/08
CRDT- 2021/07/09 05:43
PHST- 2021/02/19 00:00 [received]
PHST- 2021/06/14 00:00 [accepted]
PHST- 2021/07/09 05:43 [entrez]
PHST- 2021/07/10 06:00 [pubmed]
PHST- 2021/08/06 06:00 [medline]
PHST- 2021/07/08 00:00 [pmc-release]
AID - 10.1186/s12889-021-11338-y [pii]
AID - 11338 [pii]
AID - 10.1186/s12889-021-11338-y [doi]
PST - epublish
SO  - BMC Public Health. 2021 Jul 8;21(1):1355. doi: 10.1186/s12889-021-11338-y.