Community Health Workers Save Lives: Successfully supporting self-management of Type 2 Diabetes Mellitus
Type 2 diabetes mellitus (T2DM) is the most common form of diabetes, occurring primarily as a result of obesity and lack of exercise, as well as genetic and environmental factors - and individuals with T2DM may require support to manage their disease effectively.
According to a study by researchers at the School of Public Health (SOPH) at the University of the Western Cape, community health workers (CHWs) increasingly play roles in supporting individuals to manage their disease successfully – especially among disadvantaged populations in high-resourced settings.
The T2DM epidemic has massive consequences for individual health and national health systems, and places substantial financial burdens on individuals, families and countries. CHWs play key functions of education, support and advocacy that promote diabetes disease control. (Control typically involves exercise and dietary changes, and regular monitoring of blood sugar levels.)
The study is based on a review of published research work on the use of CHWs to provide self-management support worldwide, drawn from peer-reviewed articles produced from 2000 to 2015*. Nearly all studies are based on research conducted in high-income countries and suggest that, when well-coordinated, CHWs perform specific functions found to be effective in controlling blood sugar and reducing diabetes complications.
When the SOPH researchers looked at the activities of CHWs in supporting self-management of type 2 diabetes mellitus, they found that education was the most common function performed by them, followed by support – while advocacy was scantily provided.
The study showed that CHWs are most effective in promoting disease control when they provide a combination of the education and support roles, rather than providing any one of the functions on its own.
“The results of the study show that community health workers do play significant roles in self-management of type 2 diabetes,” says Dr Bonaventure Egbujie, PhD student from UWC’s School of Public Health, and the lead author of the study.
The study also found that CHWs were more effective in supporting disease management when individual blood sugar control was poor. When the researchers looked at how CHWs are coordinated to perform this role., they found that when CHWs are directly linked to and supervised by a nurse manager, they are more effective, compared to when another CHW supervises them or when not supervised at all.
“Together, these findings show that in low resource settings, CHWs can become a major bedrock of successful diabetes disease management,” Dr Egbujie adds, “especially with adequate training and proper coordination.”
Training Community Health Workers To Be Diabetes Management Supporters
The researchers found wide variation in how CHWs are prepared (trained) to perform these functions. Training durations ranged between a minimum of one day and a maximum of six (6) months. They note that preparation plays a significant role in determining the success of CHW-led support programmes.
“Our research thus far has indicated the important role of CHWs in T2DM self-management - and preparing and coordinating community health workers for these roles is essential for success,” study co-author and respected non-communicable disease expert, Prof Thandi Puoane, notes.
Globally, about 12% of all health expenditure is estimated to be spent on T2DM alone and its associated complications. Sub-saharan Africa presently has the lowest T2DM prevalence, but is projected to have the highest rate of increase in T2DM cases between 2015 and 2040 - a projected increase of 109%.
“Further research is needed to understand the aspects of training and coordination models that are the most effective for enhancing CHWs’ capacity to deliver T2DM self-management, especially in LMIC settings,” Prof Puoane concludes. “And then we can help fight one of the biggest health problems in the world.”The research study is part of the SMART2D (Self-Management And Reciprocal learning for the prevention and management of Type 2 Diabetes) project, and was supported through a grant from the European Union Horizon2020 Programme.
*The search was limited to articles published in English between January 2000 and December 2015. Out of 1008 studies identified, 54 full-text articles met the selection criteria and were analyzed using the Arksey and O’Malley framework for scoping studies.