#	Pagina
attuale pagina	/open-h2020/projects/194091/results.html

Report

Teaser, summary, work performed and final results

Periodic Reporting for period 2 - SMART2D (A people-centred approach through Self-Management and Reciprocal learning for the prevention and management of Type-2-Diabetes)

Teaser

Summary

Type 2 diabetes mellitus (T2DM) and pre-diabetes contribute increasingly to the global burden of disease with the health systems struggling to effectively manage prevention and control. This necessitates contextually appropriate, policy relevant solutions with high scale-up potential. The study proposal was built on a consortium experienced in implementation and cross-cultural translation of disease prevention and management. Through the SMART2D project, we aim to strengthen capacity for both T2DM prevention and care through proven strategies delivered via innovative and contextually appropriate platforms that include expansion of care networks through community-based peer support groups. The work is being carried out in three settings representing three different socioeconomic groupings: Uganda (rural under-serviced areas in a low-income setting); South Africa (urban townships in a middle-income setting); and Sweden (vulnerable immigrant groups in a high-income setting).

Work performed

An in-depth formative phase has been conducted in each of the three settings focusing on individuals (with diabetes or pre-diabetes and their families); health care professionals (both providers and managers; and community members and networks (including members employed in relevant public, private or non-governmental organizations). In-depth interviews, focus group discussions and stakeholder workshops have been conducted. A phased, consultative participatory approach has been used to discuss the findings from the formative phase and develop a complex but contextualized framework of interventions for each setting. This includes linked facility and community strategies that together address prevention (for pre-diabetes) and care and management (for T2DM). Currently, the sites are in various stages of implementing a cluster randomised adaptive implementation trial. The intervention trial started in Feb 2017 with at least two arms, a facility-only vs. a combined facility and community arm in a staggered manner, Uganda first, followed by by the other two sites. Uganda has completed recruitment while South Africa is expected to do the same by April and Sweden by June 2018. Due to unforeseen circumstances, the study design in the Swedish site has been modified to a feasibility implementation trial and will look at process outcomes more closely. Further details are provided in the Technical Report 2, for month 19-36.

Final results

The study has a strong social innovations component that is leveraging existing networks and platforms, to empower patients, their families and communities through the self-management approach. It will embed research into policy and practice from the beginning; and enable cross-lessons from other chronic conditions and reciprocal learning between sites. While strengthening existing facility-based care in Uganda and South Africa, it will reintroduce the essential but â€˜missingâ€™ community component in Sweden through an integrated community and facility component with the active support and cooperation of relevant stakeholders. This is highly relevant for Europe in tackling T2DM and other chronic conditions.
Specific expected impacts of the SMART2D project are outlined below:
- Exploratory studies to understand the background factors needed to set-up self- management support in the sub-Saharan African and European context: These studies are currently in the process of being written up. Many of them have been presented in local and international arenas and have generated significant interest. List of publications and presentations in Section 1.2.8, Table 11.
- Change to feasibility implementation trial design in the Swedish site (outlined below under deviations to Annex 1) is generating significant new knowledge on early detection and screening to access hard-to-reach populations and develop context appropriate models for peer and community support and linkages that are essential in socio- economically disadvantaged populations in Sweden and elsewhere in Europe.
- Through GACD working groups, several investigators in the SMART2D consortium (Josefien Van Olmen, Peter Delobelle, Pilvikki Absetz, David Guwatudde, Helle Alvesson, Meena Daivadanam) are participating in or leading cross-project evidence synthesis on different aspects of implementation research particularly, the relevance of contexts and concepts, process evaluations, and data standardization.