title: Effects of the First Line Diabetes Care (FiLDCare) self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines.
abstract: OBJECTIVE
  To investigate the effects of implementing a context-adapted diabetes self-management education and support (DSME/S) project based on chronic care models in the Philippines, on knowledge, attitudes, self-management practices, adiposity/obesity and glycaemia of people with diabetes.
  
  
  METHODS
  Prospective quasi-experimental before-after study.
  
  
  METHODS
  203 people with type 2 diabetes mellitus from two local government units in the Northern Philippines fulfilling set criteria.
  
  
  METHODS
  Context-adapted DSME/S was given to a cohort of people with diabetes by trained pre-existing local government healthcare personnel. Changes in knowledge, attitudes and self-management practices, body mass index, waist circumference, waist-hip ratio (WHR) and glycosylated haemoglobin (HbA1c) were measured 1 year after full project implementation. Non-parametric and parametric descriptive and inferential statistics including logistic regression analysis were done.
  
  
  RESULTS
  Complete data were collected from 164 participants. Improvements in glycaemia, waist circumference, WHR, knowledge, some attitudes, adherence to medications and exercise, and an increase in fear of diabetes were significant. Reductions in HbA1c, regardless of level of control, were noted in 60.4%. Significant increase in knowledge (p<0.001), positive attitude (p=0.013), perceived ability to control blood glucose (p=0.004) and adherence to medications (p=0.001) were noted among those whose glycaemia improved. Significant differences between the subgroups whose HbA1c improved and those whose HbA1c deteriorated include male gender (p=0.042), shorter duration of diabetes (p=0.001) and increased perceived ability to control blood glucose (p=0.042). Significant correlates to improved glycaemia were male gender (OR=2.655; p=0.034), duration of diabetes >10 years (OR=0.214; p=0.003) and fear of diabetes (OR=0.490; p=0.048).
  
  
  CONCLUSIONS
  Context-adapted DSME/S introduced in resource-constrained settings and making use of established human resources for health may improve knowledge, attitudes, self-management practices and glycaemia of recipients. Further investigations on addressing fear of diabetes and tailoring DSME/S to females with diabetes and those who have had diabetes for a longer period of time may help improve glycaemia.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Grace Marie V
authors.initials: GM
authors.lastname: Ku
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Kegels
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010679:Philippines / Q000453:epidemiology; D011320:Primary Health Care; D011446:Prospective Studies; D012648:Self Care / Q000706:statistics & numerical data*; D012938:Social Perception; D012944:Social Support; D016896:Treatment Outcome; D049629:Waist-Hip Ratio
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: EDUCATION & TRAINING (see Medical Education & Training); knowledge, attitudes, perceptions, and self-management practices; low-and-middle-income countries; self-care development
references.citation: Diabetes Care. 2009 Sep;32(9):1583-8
references.pmid: 19587364
references.citation: Diabetes Res Clin Pract. 2010 Nov;90(2):160-6
references.pmid: 20828851
references.citation: Diabetes Care. 2001 Jan;24(1):16-21
references.pmid: 11194219
references.citation: BMC Public Health. 2011 Apr 28;11:267
references.pmid: 21524316
references.citation: Chronic Illn. 2015 Jun;11(2):93-107
references.pmid: 24907237
references.citation: Diabet Med. 2007 Apr;24(4):415-23
references.pmid: 17298590
references.citation: Gend Med. 2010 Dec;7(6):593-9
references.pmid: 21195359
references.citation: BMJ. 1996 Jun 29;312(7047):1664-5
references.pmid: 8664727
references.citation: Diabetologia. 2003 Aug;46(8):1170-8
references.pmid: 12856126
references.citation: Eval Health Prof. 1996 Jun;19(2):208-30
references.pmid: 10186911
references.citation: Diabetes Care. 2004 May;27(5):1047-53
references.pmid: 15111519
references.citation: Diabetes Care. 2013 Jan;36 Suppl 1:S11-66
references.pmid: 23264422
references.citation: Am J Prev Med. 2002 May;22(4 Suppl):39-66
references.pmid: 11985934
references.citation: Arch Intern Med. 2004 Aug 9-23;164(15):1641-9
references.pmid: 15302634
references.citation: Diabet Med. 2007 Jan;24(1):55-62
references.pmid: 17227325
references.citation: Diabet Med. 2009 Apr;26(4):442-6
references.pmid: 19388976
references.citation: Diabetes Educ. 2009 May-Jun;35(3):465-75
references.pmid: 19321802
references.citation: Curr Opin Clin Nutr Metab Care. 2008 Jul;11(4):500-4
references.pmid: 18542013
references.citation: Psychol Rev. 1977 Mar;84(2):191-215
references.pmid: 847061
references.citation: Lancet. 2009 Nov 14;374(9702):1677-86
references.pmid: 19878986
references.citation: Diabetes Care. 1998 Sep;21(9):1403-7
references.pmid: 9727884
references.citation: Diabet Med. 2006 Sep;23(9):944-54
references.pmid: 16922700
references.citation: Diabetes. 2009 Apr;58(4):773-95
references.pmid: 19336687
references.citation: Rural Remote Health. 2003 Jul-Sep;3(2):220
references.pmid: 15877513
references.citation: Diabetes Educ. 2003 May-Jun;29(3):488-501
references.pmid: 12854339
references.citation: Diabetes Care. 2001 Mar;24(3):561-87
references.pmid: 11289485
references.citation: Diabetes Care. 2011 Jan;34 Suppl 1:S89-96
references.pmid: 21193633
references.citation: Diabetes Care. 1998 May;21(5):706-10
references.pmid: 9589228
references.citation: Diabetes Care. 2002 Feb;25(2):259-68
references.pmid: 11815493
references.citation: BMJ. 2008 Mar 1;336(7642):491-5
references.pmid: 18276664
references.citation: Women Health. 1993;20(4):59-70
references.pmid: 8171876
references.citation: Soc Sci Med. 1986;23(10):1105-17
references.pmid: 3823975