Abstract / Summary
Abstract Background: Treatment of diabetes requires adoption of diabetes self-management behaviours. Diabetes self management education and peer support are likely to promote adoption of these behaviours.
Objectives: To study the feasibility, adoption, acceptability of a diabetes peer support intervention in a rural community in Tamil Nadu.
Methods: We implemented a diabetes peer support intervention with 29 peer support groups in 29 villages served by a voluntary health organization as part of a cluster randomized controlled trial. At the end of the 2 year intervention we conducted in depth interviews with all 10 community health workers who facilitated the trial in the field, 6 purposively sampled members from the control group and 10 focus group discussions among 43 members in 10 different peer support groups sampled based on gender, caste and percentage attendance in the group meetings over 2 years. We analyzed the transcripts using the Consolidated Framework for Implementation Research domains.
Results: The facilitators of adoption, acceptability and sustainability of the intervention included empowerment of the community health workers with knowledge about diabetes, confidence, joy, wellbeing and gain of knowledge by the members of the peer support groups, empowerment of the members by the monthly monitoring of blood sugars and blood pressure, readily available medical consultation over mobile phone to clarify doubts and forging strong bonds between the community health workers and the community. The barriers included challenges faced by elderly and persons with disabilities in attending the meetings, complexity of some of the self management interventions like Yoga, workload of working persons, gendered social roles preventing attendance in meetings, inefficient public health system making basic care inaccessible, digital divide preventing use of mHealth content, low literacy levels, male alcoholism impairing engagement and harassment and violence experienced by the female community health workers in the villages.
Conclusions: It is feasible to form peer support groups and provide diabetes self-management education through this platform however sustainability will require addressing some limitations in design of the intervention and navigating inner and outer setting complexities.