The effect of a community-based intervention on self-care behaviours among people with type 2 diabetes in Nepal

Introduction: Health behavioural interventions led by community health workers (CHWs) and peer supporters effectively promote self-care behaviours among people with type 2 diabetes mellitus (T2DM). Few such interventions have been conducted in low-income countries including in Nepal. This study assessed the effectiveness of a community-based behavioural intervention with CHWs and peer supporters in promoting the self-care behaviours of people with T2DM in Nepal. Methods: The cluster randomised controlled trial was conducted with 481 participants with T2DM in the Kavrepalanchowk and Nuwakot districts of Nepal. The intervention included 12 educational sessions on different key components of diabetes management and was implemented over 6 months. The primary outcomes (dietary intake, physical activity, medication intake, blood glucose monitoring and foot care) were assessed at baseline and 6 months post-intervention. The intervention effect was analysed using the generalised estimating equation (GEE) based on the intention-to-treat (ITT) principle. Results: The mean (SD) age of the study participants was 54.4 (9.4) years and most of them were males (52.8%). Of 12 intervention sessions, 45.4% of intervention participants attended ≤ 6 sessions, 39% attended 7–11 sessions and only 15.5% attended all twelve sessions. The findings show that physical activity and blood glucose monitoring increased by 3.8% and 7.1%, respectively in the intervention participants compared to control participants while the practice of a healthy diet, medication intake and foot care decreased by − 8.4%, − 4.3% and − 1.3%, respectively. Similarly, intervention participants exhibited higher odds of increasing physical activity (1.6, 0.76–3.49) and blood glucose monitoring (1.3, 0.80–2.33) than control participants. However, these findings were not statistically significant. Conclusion: The findings indicate that the CHWs and peer supporters-led behavioural intervention did not show improvements in the self-care behaviours of people with T2DM. Multiple factors may have contributed to this including poor attendance of the educational sessions, short intervention duration, and travel restrictions due to the COVID-19 pandemic. Therefore, future research should adopt strategies to achieve the highest exposure to the intervention sessions and longer-term intervention duration.