Feasibility of the Diabetes Self-Management Coaching Program Among Individuals with Uncontrolled Type 2 Diabetes in Primary Care in Ethiopia: A Concurrent Mixed-Method Feasibility Randomized Controlled Trial

Abstract

Background. Diabetes mellitus is a global public health problem affecting over half a billion people. Over 80% of individuals with diabetes live in low- and middle-income countries where the health system is not well-positioned to mitigate the impact of diabetes. Diabetes self-management is a cornerstone in supporting individuals to acquire the necessary knowledge, skills, and experience of self-management. Health coaching is a client-centered collaborative self-management support to enhance the development of autonomy, competence, self-efficacy, and positive relationships. Health coaching has shown a promising effect in changing the clinical and behavioral outcomes of individuals with diabetes. Methods. This dissertation employed a concurrent mixed-method feasibility randomized controlled trial to examine the feasibility and acceptability of the Diabetes Self-Management Coaching program in primary care and evaluate the potential effectiveness of the program on glycosylated hemoglobin, diabetes self-efficacy, diabetes self-care activity, and health-related quality of life among individuals with uncontrolled diabetes in Ethiopia. Results. The study found remarkable recruitment, adherence, retention, and acceptability rates despite a low eligibility rate. The findings revealed that the 12-week self-management coaching program was feasible in primary care settings and acceptable by individuals with type 2 diabetes. The preliminary effectiveness findings of the Diabetes Self-Management Coaching program indicates a potentially meaningful clinical benefit, particularly in glycemic control. In addition, favorable differences in diabetes self-efficacy and diabetes self-care activities were observed at follow-up, suggesting that the coaching program may strengthen participants’ confidence and engagement in diabetes self-management behaviors. However, the absence of notable changes in body mass index, blood pressure, and health-related quality of life points to areas where the intervention may need revisions in duration or intervention delivery. Conclusion. The 12-week Diabetes Self-Management Coaching program was feasible in primary care in Ethiopia, acceptable by individuals with type 2 diabetes, and showed a promising improvement in the clinical and behavioral outcomes in primary care. Therefore, this mixed-method feasibility RCT provides a foundation for a multi-center, a large-scale, definitive randomized controlled trial to assess the clinical, behavioral, social, and emotional outcomes in primary care settings.