The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: a systematic review.
Journalsystematic reviews2.479Date
2020 Jun 06
5 months ago
Journal Article
2020-Jun-06 / 9 : 133
Werfalli M 1, 2, Raubenheimer PJ 2, Engel M 2, Musekiwa A 3, Bobrow K 1, 2, Peer N 2, 3, Hoegfeldt C 4, Kalula S 2, 5, Kengne AP 2, 6, Levitt NS 7, 8, 9
  • 2. Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape, 7935, South Africa.
  • 3. Chronic Diseases of Lifestyle Research Unit, Durban, Durban, South Africa.
  • 4. Department of Psychiatry, University of Oxford, Oxford, UK.
  • 5. Department of Geriatric Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western Cape, South Africa.
  • 6. South African Medical Research Council, Cape Town, South Africa.
  • 7. Chronic Disease Initiative for Africa, Cape Town, Western Cape, South Africa. [email protected]
  • 8. Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape, 7935, South Africa. [email protected]
  • 9. Division of Endocrinology and Diabetes, Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, J 47 Room 86, Old Groote Schuur Hospital Building, Cape Town, South Africa. [email protected]
OBJECTIVE: Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries' (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes.
METHODS: We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform,, Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided.
RESULTS: Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible.
CONCLUSIONS: The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.
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