RT Journal Article
SR Electronic
T1 EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND)—a feasibility study in Mozambique and Malawi
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e047425
DO 10.1136/bmjopen-2020-047425
VO 11
IS 9
A1 Emer M Brady
A1 The EXTEND Collaborative
A1 Catherine Bamuya
A1 David Beran
A1 Jorge Correia
A1 Amelia Crampin
A1 Albertino Damasceno
A1 Melanie J Davies
A1 M Hadjiconstantinou
A1 Deirdre Harrington
A1 Kamlesh Khunti
A1 Naomi Levitt
A1 Ana Magaia
A1 Jayna Mistry
A1 Hazel Namadingo
A1 Anne Rodgers
A1 Sally Schreder
A1 Leopoldo Simango
A1 Bernie Stribling
A1 Cheryl Taylor
A1 Ghazala Waheed
YR 2021
UL http://bmjopen.bmj.com/content/11/9/e047425.abstract
AB Background Globally, there are estimated 425 million people with type 2 diabetes (T2D) with 80% from low-middle income countries (LMIC). Diabetes self-management education (DSME) programmes are a vital and core component of the treatment pathway for T2D. Despite LMIC being disproportionally affected by T2D, there are no DSME available that meet international diabetes federation criterion.Methods The aims were to test the feasibility of delivering a proven effective and cost-effective approach used in a UK population in two urban settings in Malawi and Mozambique by; (1) developing a culturally, contextually and linguistically adapted DSME, the EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND) programme; (2) using a mixed-method approach to evaluate the delivery of training and the EXTEND programme to patients with T2D.Results Twelve healthcare professionals were trained. Ninety-eight participants received the DSME. Retention was high (100% in Mozambique and 94% in Malawi). At 6 months HbA1c (−0.9%), cholesterol (−0.3 mmol/L), blood pressure (−5.9 mm Hg systolic and −6.1 mm Hg diastolic) improved in addition to indicators of well-being (problem areas in diabetes and self-efficacy in diabetes).Conclusion It is feasible to deliver and evaluate the effectiveness of a culturally, contextually and linguistically adapted EXTEND programme in two LMIC. The DSME was acceptable with positive biomedical and psychological outcomes but requires formal testing with cost-effectiveness. Challenges exist in scaling up such an approach in health systems that do not have resources to address the challenge of diabetes.No data are available. The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Raw data that support the findings of this study are available from the corresponding author (EMB, MJD) upon reasonable request.