Effectiveness of a group diabetes education programme in under-served communities in South Africa: a pragmatic cluster randomized controlled trial.
OBJECTIVE
To evaluate the effectiveness of group education, led by health promoters using a guiding style, for people with type 2 diabetes in public sector community health centres in Cape Town.


METHODS
This was a pragmatic clustered randomized controlled trial with 17 randomly selected intervention and 17 control sites. A total of 860 patients with type 2 diabetes, regardless of therapy used, were recruited from the control sites and 710 were recruited from the intervention sites. The control sites offered usual care, while the intervention sites offered a total of four monthly sessions of group diabetes education led by a health promoter. Participants were measured at baseline and 12 months later. Primary outcomes were diabetes self-care activities, 5% weight loss and a 1% reduction in HbA(1c) levels. Secondary outcomes were self-efficacy, locus of control, mean blood pressure, mean weight loss, mean waist circumference, mean HbA1c and mean total cholesterol levels and quality of life.


RESULTS
A total of 422 (59.4%) participants in the intervention group did not attend any education sessions. No significant improvement was found in any of the primary or secondary outcomes, apart from a significant reduction in mean systolic (-4.65 mmHg, 95% CI 9.18 to -0.12; P = 0.04) and diastolic blood pressure (-3.30 mmHg, 95% CI -5.35 to -1.26; P = 0.002). Process evaluation suggested that there were problems with finding suitable space for group education in these under-resourced settings, with patient attendance and with full adoption of a guiding style by the health promoters.


CONCLUSIONS
The reported effectiveness of group diabetes education offered by more highly trained professionals, in well-resourced settings, was not replicated in the present study, although the reduction in participants' mean blood pressure is likely to be of clinical significance.
Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa.
R J
RJ
Mash
H
H
Rhode
M
M
Zwarenstein
S
S
Rollnick
C
C
Lombard
K
K
Steyn
N
N
Levitt
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D003151:Community Health Centers; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006126:Group Processes; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D006973:Hypertension / Q000150:complications / Q000517:prevention & control*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D013019:South Africa; D055105:Waist Circumference; D015431:Weight Loss