肯尼亚内罗毕非正式定居点患者支持小组护理模式对糖尿病和高血压护理的可行性及影响：一项准实验研究
Feasibility and impact of a patient support group care model on diabetes and hypertension care in informal settlements in Nairobi, Kenya: a quasi-experimental study.
作者信息
Sanya Richard E, Karugu Caroline H, Iddi Samuel, Kibe Peter M, Mburu Lilian, Mbau Lilian, Kibe Victor, Mahone Sloan, Levitt Naomi S, Klipstein-Grobusch Kerstin, Asiki Gershim
机构信息
Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya.
Department of Public and Occupational Health, Amsterdam Public Health, University of Amsterdam Medical Centers, Amsterdam, The Netherlands.
出版信息
Glob Health Action. 2025 Dec;18(1):2482304. doi: 10.1080/16549716.2025.2482304. Epub 2025 Apr 9.
BACKGROUND
A support group care model including self-financing is a promising strategy to improve care for patients with diabetes or hypertension in resource-constrained settings.
OBJECTIVES
We investigated the uptake, feasibility, and impact of a self-financing patient support group care model on cardiometabolic parameters among adult patients with uncontrolled diabetes or hypertension in informal settlements in Nairobi, Kenya.
METHODS
A two-group prospective quasi-experimental study was conducted. The outcomes were changes in mean glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, and waist-hip ratio in control versus intervention communities, assessed 6 months after intervention implementation.
RESULTS
At baseline, 118 patients with diabetes (intervention, 60; control, 58) and 176 with hypertension (intervention, 87; control, 89) were enrolled. At endline, 81 patients with diabetes and 137 with hypertension were surveyed. In the intervention arm, HbA1c decreased from 10.8% to 9.0% (mean difference [95% CI]: -1.7 [-2.4, -0.9] < 0.001) and in the control arm from 10.6% to 9.9% (-0.9 [-1.5, -0.3] = 0.005). Difference-in-difference analysis showed a notably greater reduction in HbA1c in the intervention arm (-0.942 [0.463] < 0.05). In the intervention arm, SBP decreased from 155.0 mmHg to 148.7 mmHg (-6.3 [-11.7, -0.9] = 0.022) and in the control arm, from 160.1 mmHg to 152.5 mmHg (-7.6 [-12.9, -2.3] = 0.005). DBP in the intervention arm changed from 99.1 mmHg to 97.9 mmHg (-1.1 [4.2, 1.9] = 0.462) and in the control arm from 99.7 mmHg to 94.8 mmHg (-4.9 [7.8, -2.0] = 0.001).
CONCLUSIONS
A self-financing patient support group care model is feasible, improves cardiometabolic parameters and can be a strategy to manage diabetes, hypertension, and other chronic diseases in low-resource settings.
背景
包括自筹资金在内的支持小组护理模式是在资源有限的环境中改善糖尿病或高血压患者护理的一种有前景的策略。
目的
我们调查了自筹资金的患者支持小组护理模式对肯尼亚内罗毕非正规住区未得到有效控制的糖尿病或高血压成年患者心脏代谢参数的接受程度、可行性及影响。
方法
进行了一项两组前瞻性准实验研究。结局指标为干预实施6个月后，对照社区与干预社区中糖化血红蛋白（HbA1c）、收缩压（SBP）、舒张压（DBP）、体重指数及腰臀比的均值变化。
结果
基线时，纳入了118例糖尿病患者（干预组60例，对照组58例）和176例高血压患者（干预组87例，对照组89例）。在终末随访时，对81例糖尿病患者和137例高血压患者进行了调查。在干预组，HbA1c从10.8%降至9.0%（平均差值[95%CI]：-1.7[-2.4, -0.9]<0.001），对照组从10.6%降至9.9%（-0.9[-1.5, -0.3]=0.005）。差值法分析显示干预组HbA1c的降低幅度显著更大（-0.942[0.463]<0.05）。在干预组，SBP从155.0mmHg降至148.7mmHg（-6.3[-11.7, -0.9]=0.022），对照组从160.1mmHg降至152.5mmHg（-7.6[-12.9, -2.3]=0.005）。干预组DBP从99.1mmHg变为97.9mmHg（-1.1[4.2, 1.9]=0.462），对照组从99.7mmHg变为94.8mmHg（-4.9[7.8, -2.0]=0.001）。
结论
自筹资金的患者支持小组护理模式是可行的，可改善心脏代谢参数，并且可以作为在资源匮乏地区管理糖尿病、高血压及其他慢性病的一种策略。
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