Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods...

Area of Science:

• Global Health
• Diabetes Management
• Public Health Interventions

Background:

• The global diabetes epidemic necessitates effective lifestyle interventions.
• Diabetes self-management education and support (DSMES) is crucial for managing diabetes.
• Rural Indigenous populations face unique challenges in diabetes care.

Purpose of the Study:

• To assess the implementation and effectiveness of a culturally adapted, home-based DSMES intervention.
• To evaluate clinical and psychometric outcomes in a rural Indigenous Maya population.
• To identify barriers and facilitators for scaling up DSMES in resource-limited settings.

Main Methods:

• A mixed-methods evaluation framework (RE-AIM) was used.
• A pretest-posttest design enrolled 627 participants in rural Guatemala.
• Quantitative data (clinical measures, costs) and qualitative data (stakeholder interviews) were collected.

Main Results:

• Significant improvements were observed in glycated hemoglobin A1c (-0.4%), blood pressure (-5.0/-2.6 mm Hg), and body mass index (+0.5).
• Diabetes knowledge, distress, and self-care activities showed positive changes.
• Implementation challenges included recruitment barriers for men and sustainability concerns.

Conclusions:

• A community health worker-led DSMES intervention was successfully implemented and effective in rural Guatemala.
• Patient-centered care and health worker involvement were key facilitators.
• Sustainable scale-up necessitates addressing local barriers and facilitators within health systems.