Diabetes Research Programme - DM07

SMART2D - A people-centred approach through Self-Management and Reciprocal learning for the prevention and management of Type-2-Diabetes

Project Locations: Stockholm, Sweden; Iganga-Mayuge, Uganda; Langa township, Cape Town, South Africa

Funding organisation

European Commission, EU

Problem Statement and Overall Aim

Formal Health Services will be overwhelmed by the magnitude of the T2DM burden. In addition healthcare services are often poorly accessible, acceptable, available, affordable or adequate (5As of access) to the needs of the target population in low- and middle-income countries and, especially among the urban vulnerable immigrant groups, in high-income countries, resulting in poor prevention and management of T2DM.

Our overall aim therefore is to strengthen capacity for T2DM care (both prevention and management), through proven strategies like task-shifting to non-physician health care providers and community health workers, and expanding care networks through community-based peer support groups. Our target population is adult men and women at high-risk for or diagnosed with T2DM, i.e., individuals with pre-diabetes and diabetes in the three settings.

Research objectives and methodology

To this end, we propose the following overall and specific objectives:

Primary research objectives

To formulate and implement a contextually appropriate self-management approach through facility and community components for prevention and control of T2DM in three settings
To evaluate the outcome of the self-management approach and the added benefit of the community component compared to the facility component; and in dialogue with stakeholders
To translate the research findings at each stage into relevant input for national guidelines and policies in each setting and for reciprocal transfer of knowledge across sites.

Study settings

In order to demonstrate the feasibility of this project in diverse settings, the proposed project will have three field sites: 1) The Iganga-Mayuge Health & Demographic Surveillance Site (IMHDSS), which is a largely rural setting in eastern Uganda, a low-income country; 2) Langa and Khayelitsha in South Africa, representing urban townships in a middle-income country; and 3) four urban communities in Stockholm county with a predominant immigrant population representing vulnerable urban groups in Sweden, a high-income country.

The study has a strong social innovations component that is leveraging existing networks and platforms, to empower patients, their families and communities through the self-management approach. It will embed research into policy and practice from the beginning; and enable cross-lessons from other chronic conditions and reciprocal learning between sites. While strengthening existing facility-based care in Uganda and South Africa, it will reintroduce the essential but ‘missing’ community component in Sweden through an integrated community and facility component with the active support and cooperation of relevant stakeholders. This is highly relevant for Europe in tackling T2DM and other chronic conditions.

Current Status

An in-depth formative phase has been conducted in each of the three settings focusing on individuals (with diabetes or pre-diabetes and their families); health care professionals (both providers and managers; and community members and networks (including members employed in relevant public, private or non-governmental organizations). In-depth interviews, focus group discussions and stakeholder workshops have been conducted. A phased, consultative participatory approach has been used to discuss the findings from the formative phase and develop a complex but contextualized framework of interventions for each setting. This includes linked facility and community strategies that together address prevention (for pre-diabetes) and care and management (for T2DM). Currently, the sites are preparing for the pilot phase when an iterative process of modifications and improvements will be made to finalize the intervention framework. Additionally, environment challenges particularly those relating to the food environment will be dealt with in more detail in South Africa and Sweden. The intervention trial is set to start in Jan 2017 with at least two arms, a facility-only vs. a combined facility and community arm.

Project contact: Meena Daivadanam - meena.daivadanam@ikv.uu.se

Investigators