The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low-and-middle-income countries: A systematic review

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dc.contributor.authorWerfalli, M.
dc.contributor.authorRaubenheimer, P.J.
dc.contributor.authorEngel, M.
dc.contributor.authorMusekiwa, A.
dc.contributor.authorBobrow, K.
dc.contributor.authorPeer, N.
dc.contributor.authorHoegfeldt, C.
dc.contributor.authorKalula, S.
dc.contributor.authorKengne, A.P.
dc.contributor.authorLevitt, N.S.
dc.contributor.departmentSouth African Medical Research Councilen_US
dc.date.accessioned2023-04-17T12:42:24Z
dc.date.available2023-04-17T12:42:24Z
dc.date.epub2020
dc.date.issued2020-06-06
dc.description.abstractObjective: Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries' (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes. Methods: We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform, Clinicaltrials.gov, Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided. Results: Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible. Conclusions: The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.en_US
dc.identifier.citationWerfalli M, Raubenheimer P.J, Engel M. et al. The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: A systematic review. Syst Rev 9, 133 (2020). https://doi.org/10.1186/s13643-020-01377-8en_US
dc.identifier.doi10.1186/s13643-020-01377-8
dc.identifier.journalSystematic Reviewsen_US
dc.identifier.urihttps://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01377-8
dc.identifier.urihttps://infospace.mrc.ac.za/handle/11288/595303
dc.language.isoenen_US
dc.publisherBMCen_US
dc.research.unitNon-Communicable Disease Research Uniten_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subjectSystematic reviewen_US
dc.subjectHealth workeren_US
dc.subjectDiabetesen_US
dc.subjectLow and middle income countriesen_US
dc.titleThe effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low-and-middle-income countries: A systematic reviewen_US
dc.typeArticleen_US
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