Objectives

To apply the ‘Diabetes Self-Management Education’ (DSME) model in two different health system settings in rural Mayan communities, i.e 

1) A ‘traditional’ health district setting where auxiliary nurses/CHWs are based at health posts
2) ‘MIS’ health district setting where a multidisciplinary community health team provides care at clinic, community and household levels. 

Approach

• Revision of DSME training curriculum for nurses and CHWs, incl. adaptation to local language and culture. Curriculum to be reviewed by project steering committee with members from all stakeholders and aligned with national guidelines.
• Training of nurses and CHWs within home-based DSME based on newly revised curriculum through two-day theoretical course and three-day practical course; practical course to include supported supervision with patient involvement.
• Roll out of project in two districts, each representing one health system setting; diabetes patients to be recruited from local clinics and provided with home-based DSME delivered by the trained nurses and CHWs. Family members to be involved during sessions.
• Monitoring/evaluation of project outcomes, incl. patient self-care and comparison of outcomes in the two different health system settings.
• Evaluation to advocate for national level scale up; national workshop to be conducted for policy makers. A policy brief with lessons learned and applicability assessment across Central America, prepared by INCAP, to be presented to key public sector leaders.

Expected results

• 6 doctors, 55 nurses and 10 CHWs trained to implement the DSME
• 1,000 patients trained in self-management, 500 from each system setting. Each patient to receive eight home-based educational sessions. Improved patient glucose control and lifestyle/dietary changes expected
• 2,000 family members trained during home-based education sessions
• An estimated 140,000 people (population of targeted districts) gain access to improved diabetes care at community level
• Baseline/midway/end-line evaluation to be conducted on performance and clinical indicators, incl. BMI, blood glucose and blood pressure  

Results upon completion:

• 18 doctors, 76 nurses and 21 CHWs trained to implement the DSME
• 770 patients trained in self-management. Each patient to receive eight home-based educational sessions. Improved patient glucose control and lifestyle/dietary changes expected
• 2,874 family members trained during home-based education sessions
• An estimated 110,000 people (population of targeted districts) gain access to improved diabetes care at community level
• Baseline/midway/end-line evaluation was conducted on performance and clinical indicators, incl. BMI, blood glucose and blood pressure