Evaluating the implementation of Group Empowerment and Training (GREAT) for diabetes in South Africa

Background

Diabetes is a leading contributor to the burden of disease in South Africa. The new National Strategic Plan for non-communicable diseases aims to achieve control in 50% of patients. Currently, in the Western Cape, only 25% are controlled and a lack of patient education and counselling is a key factor. Group empowerment and training (GREAT) for type 2 diabetes in the primary care setting is a feasible and cost-effective intervention in our setting.

Aims

This study aims to evaluate the scale-up and implementation of GREAT for diabetes in primary care across all provinces in South Africa. Target population: Adult male and females in South Africa with type 2 diabetes, dependent on the public sector primary health care services.

Project plan

The World Diabetes Foundation funded the implementation of GREAT for diabetes in a separate project. Implementation started by engagement with the National Department of Health in 2019, who introduced the project to the nine Provincial Departments of Health. The project team then met with the Provincial management and the management from one selected health district per province. Following this the district management helped to organise the training of facilitators in a 3-day workshop from 10 primary care facilities per district. The workshop included a half-day engagement with the facility managers on the organisational issues. The team then supported and monitored implementation over 6-months.

Implementation was seriously disrupted by the COVID-19 pandemic in 2020-2021. The project had to be re-initiated post-COVID at the end of 2021.

The GACD and SA Medical Research Council funded the evaluation of implementation. A convergent mixed methods study was conducted in 2022, 12-weeks after GREAT for diabetes was re-initiated. The study collected qualitative (semi-structured interviews with all stakeholders) and quantitative data in all provinces where GREAT was implemented. Data was used to evaluate key implementation outcomes: adoption, feasibility, fidelity, coverage, cost and sustainability.

Publications and output

You can also visit the GREAT for diabetes website and the Stellenbosch University project webpage for more information.

This project has a related case study Empowering people with diabetes in South Africa through the GREAT project.

Principal investigators

Team members

Funding organisations

•