Improving self-management for diabetes in diverse settings: example of Reciprocal Learning Approach

Abstract

Background Type 2 diabetes (T2D) is seriously burdening already fragile health systems in low-and middle-income countries and well-established primary care in high-income countries. Using the concept of reciprocal learning, the SMART2D project (Self-Management and Reciprocal learning for Type 2 Diabetes) has partnered with communities and health facilities to improve diabetes-related outcomes. Methods We selected a rural setting in Uganda; an urban township in South Africa; and disadvantaged suburbs in Sweden. The reciprocal learning process was structured through three learning cycles, using the Evidence Integration Triangle: 1) problem clarification and developing a common Theory of Change; 2) development and contextualization of evidence-based intervention strategies; and 3) implementation and evaluation of the contextualized strategies to improve self-management. Central across all, is multi-level partnerships with local stakeholders. Results The differences between the settings highlighted specific needs and strengths, such as established community pathways for chronic care (HIV and AIDS) in Uganda and South Africa; and the predominantly facility-based care in Sweden. We identified opportunities for contextualisation, such as development of T2D treatment algorithms (Uganda); partnering with local governments and NGOs for community strategies (Sweden); and addressing the local food environment (South Africa). A common intervention framework comprising facility and community strategies was aligned to site-specific needs and is currently being implemented and evaluated in 'real-life setting' using an adaptive implementation trial. Conclusions The three selected settings have very different baseline characteristics and needs. The reciprocal learning process allows for knowledge transfer and application and enabled the development of contextualized intervention strategies tailored