Effect of an Intensive Outpatient Diabetes Education Programme (IODEP) on Personal, Environmental, and Behavioural Factors, and Glycosylated Haemoglobin Levels in Ghanaians with Type 2 Diabetes

Habibu, Issah (2024) Effect of an Intensive Outpatient Diabetes Education Programme (IODEP) on Personal, Environmental, and Behavioural Factors, and Glycosylated Haemoglobin Levels in Ghanaians with Type 2 Diabetes. PhD thesis, University of Malaysia, Sarawak.

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Abstract

Type 2 Diabetes Mellitus (T2DM) prevalence is rapidly increasing in sub-Saharan Africa, with limited evidence for effective diabetes education interventions in low-resource settings. This study evaluated the effectiveness of the Intensive Outpatient Diabetes Education Programme (IODEP), a Social Cognitive Theory-based intervention, on clinical and psychosocial outcomes among individuals with T2DM in Northern Ghana. It also examined the relationships between these factors and their influence on glycemic control. A quasi-experimental design with 245 participants (intervention: n=125; comparison: n=120) was conducted over six months at two hospitals in Ghana: Tamale Teaching Hospital (intervention group) and Tamale Regional Hospital (comparison group). The intervention group received six structured diabetes education modules delivered biweekly/monthly, while the comparison group received standard care. Outcomes included HbA1c levels, diabetes knowledge, self-efficacy, patient involvement, satisfaction with care, social support, provider communication, and self-management behaviors. The intervention achieved significant improvements across multiple domains. HbA1c levels decreased by 1.8% (95% CI: -2.3 to -1.3, p < 0.001) in the intervention group compared to the comparison group. Significant improvements were observed in self-efficacy (+15.4 points, p < 0.001), social support (+10.2 points, p < 0.001), and self-management behaviors (+18.5%, p < 0.001). Multiple regression analysis revealed that 71% of HbA1c variance was explained by personal, environmental, and behavioral factors, with self-management behaviors (β = -0.38) and self-efficacy (β = -0.32) as the strongest predictors. Mediation analysis confirmed that self-management behaviors mediated the relationships between psychosocial factors and clinical outcomes. The quasi-experimental design limits causal inference capabilities, and the six-month follow-up period may have been insufficient to capture long-term sustainability of improvements. Self-report measures for behavioral outcomes may have introduced measurement bias, and the disconnect between improved provider communication and glycemic control suggests complex relationships requiring further investigation. The IODEP intervention demonstrated substantial clinical effectiveness in a low-resource setting, with the 1.8% HbA1c reduction representing one of the largest improvements reported for diabetes education interventions in sub-Saharan Africa. The findings validate Social Cognitive Theory’s application in this context and identify self-efficacy enhancement and practical skill development as critical intervention components. These results support the integration of structured diabetes education into Ghana’s healthcare system and provide a replicable model for other sub-Saharan African countries. This study provides crucial evidence for diabetes care improvement in resource-constrained settings and offers practical guidance for scaling effective diabetes education interventions across sub-Saharan Africa. Keywords: Type 2 diabetes, diabetes education, Social Cognitive Theory, Ghana, HbA1c, quasi-experimental design, self-efficacy, low-resource settings

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