Public Health Research Program, School of Public Health, Walailak University, Nakhon Si Thamarata, Thailand.
Excellent Center of Dengue and Community Public Health (EC for DACH), Walailak University, Nakhon Si Thamarata, Thailand.
PLoS One. 2024 Oct 15;19(10):e0305860. doi: 10.1371/journal.pone.0305860. eCollection 2024.
Diabetes poses a significant public health challenge, predominantly affecting low-and middle-income countries (LMICs), including in Sub-Saharan Africa (SSA). The evolving landscape characterized by resource constraints, gaps in availability and functionality of healthcare system, and socio-demographic impediments has compounded these challenges. As an example, self-care interventions have played a crucial role in diabetes care. However, the effectiveness of these interventions in the SSA remains insufficiently explored. Therefore, this systematic review evaluated the effectiveness and implementation approach of diabetes self-care interventions in SSA.
A comprehensive search was conducted across electronic databases including PubMed, Scopus, and Google Scholar, to identify studies focusing on diabetes self-care interventions in SSA from 2013 to 2023. The included studies reported interventions targeting dietary adherence, physical activity, medication adherence, blood glucose monitoring, foot care, and educational or support programs. The quality of the studies was assessed using the JBI checklist. Effectiveness was assessed through outcomes including glycemic control, adherence rate, complication reduction, and improvement in patient outcomes.
Overall, 38.5% of interventions result showed positive changes in either primary or secondary outcomes. Studies that employed diabetes self-management education showed positive changes in approximately 28.6% of cases. However, SMS text messaging interventions did not demonstrate significant changes in the measured outcomes. Of the 13 studies reviewed, 12 used randomized controlled trial designs, whereas one study employed a quasi-experimental approach. The total of participants across intervention and control groups was 3172 adults with diabetes. The interventions employed various strategies including diabetes self-management education led by nurses and other professionals, SMS text messaging for treatment adherence, and other targeted approaches. The duration of these interventions varied from 2 to 12 months. Specific interventions, such as glucose machine provision with training, family support with culturally tailored educations, and periodontal treatment, exhibited notable improvement in adherences and reductions in HbA1c levels.
The review underscores the significance of diabetes self-care interventions in SSA, showing varying effectiveness levels across different strategies. It emphasizes the importance of tailored approaches and highlight interventions that have shown promising outcomes, providing insights for future research, policy, and healthcare strategies in the region.
糖尿病是一个重大的公共卫生挑战，主要影响低收入和中等收入国家（LMICs），包括撒哈拉以南非洲（SSA）。资源有限、医疗保健系统可用性和功能差距以及社会人口障碍等不断变化的情况加剧了这些挑战。例如，自我护理干预在糖尿病护理中发挥了重要作用。然而，这些干预措施在 SSA 的有效性尚未得到充分探索。因此，本系统评价评估了 SSA 中糖尿病自我护理干预的有效性和实施方法。
通过全面搜索电子数据库，包括 PubMed、Scopus 和 Google Scholar，从 2013 年到 2023 年，确定了 SSA 中针对糖尿病自我护理干预的研究。纳入的研究报告了针对饮食依从性、身体活动、药物依从性、血糖监测、足部护理以及教育或支持计划的干预措施。使用 JBI 清单评估研究质量。通过血糖控制、依从率、并发症减少和患者结局改善等结果评估有效性。
总体而言，38.5%的干预措施显示主要或次要结局有积极变化。采用糖尿病自我管理教育的研究显示，约 28.6%的情况下出现积极变化。然而，短信文本消息干预并未在测量结果中显示出显著变化。在审查的 13 项研究中，有 12 项使用了随机对照试验设计，而有一项研究采用了准实验方法。干预组和对照组的总参与者为 3172 名患有糖尿病的成年人。所采用的干预措施包括由护士和其他专业人员领导的糖尿病自我管理教育、用于治疗依从性的短信文本消息以及其他针对性方法。这些干预措施的持续时间从 2 到 12 个月不等。具体干预措施，如提供血糖仪并进行培训、家庭支持和文化适应性教育、牙周治疗等，在依从性和降低 HbA1c 水平方面显示出显著改善。
本综述强调了 SSA 中糖尿病自我护理干预的重要性，显示了不同策略的有效性水平不同。它强调了针对性方法的重要性，并突出了显示出有希望结果的干预措施，为该地区的未来研究、政策和医疗保健策略提供了见解。
