Original Research

The sustainability of group empowerment and training for people with diabetes in South Africa

Robert J. Mash, Darcelle Schouw
South African Family Practice | Vol 66, No 1 : Part 2| a5918 | DOI: https://doi.org/10.4102/safp.v66i1.5918 | © 2024 Robert J. Mash, Darcelle Schouw | This work is licensed under CC Attribution 4.0
Submitted: 29 January 2024 | Published: 06 May 2024

About the author(s)

Robert J. Mash, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Darcelle Schouw, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract

Background: Group empowerment and training (GREAT) for people with type 2 diabetes enables self-management and lifestyle modification. GREAT for diabetes was implemented in primary care facilities in five South African provinces in the beginning of 2022. The aim was to evaluate implementation and to particularly explore factors that influenced the sustainability of implementation.

Methods: An exploratory, descriptive qualitative study conducted semi-structured individual interviews with 17 key stakeholders at the end of 2023. Interviews explored factors within a theory of change framework derived from an initial evaluation in 2022. Data were analysed using the framework method and ATLAS.ti.

Results: Implementation and scale-up was sustained in the Western Cape. Governance and financing at a provincial and district level were key to health system structures. Space, staffing, resource materials and monitoring of implementation were key to the inputs. Facility managers, training and performance of facilitators, including the whole team, selecting patients, patient flow and appointments, stakeholder support and clinical governance were key to service delivery. Facilities that had implemented, reported reaching 300 patients per year. A range of motivational, behavioural and clinical outcomes were reported. Future implementation could include community health workers and group empowerment for insulin initiation.

Conclusion: Implementation and scale-up was only sustained in one province and a range of factors related to sustained implementation were identified.

Contribution: The factors identified can guide the successful implementation and scale-up of GREAT for diabetes in South Africa.


Keywords

diabetes; group empowerment; group education; self-management; implementation; sustainability.

Sustainable Development Goal

Goal 3: Good health and well-being

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