Primary Caregiver Social Support and Its Influence on Self-Management Adherence among Type II Diabetes Patients in Machakos County, Kenya

Abstract

The increase in Type II diabetes Mellitus (T2DM) in sub-Saharan Africa is expected to outpace all other global regions, with an estimated 55 million T2DM patients projected by 2045. For T2DM patients, self-management, which encompasses self-monitoring blood glucose, diet, physical exercise, and medication adherence, improves glycemic control and can prevent diabetes-related complications. However, adhering to these practices can be complex, making it challenging to meet self-management goals. There is increasing evidence that social support, often measured in three dimensions —tangible, emotional, and informational —can impact adherence to diabetes self-management. Unfortunately, investigations of this contribution to T2DM patient self-management adherence, including structured and feasible social support approaches in Kenya, are limited. This six-month study aimed to evaluate the impact of primary caregiver social support on improving adherence to self-management among T2DM patients in Machakos County. The study employed a quasi-experimental design that utilised both quantitative and qualitative data collection approaches in Matungulu (experimental site) and Masinga (control site) sub-counties. The intervention at the experimental site included training primary caregivers in T2DM self-management practices and social support requirements, developing and implementing a diabetes care plan, and pairing the primary caregiver with a health worker for continuous support over a six-month period. Data analysis was conducted using both descriptive (means, frequencies) and inferential statistics (Chi-square, unpaired t-test, difference-in-differences, logistic regression). All hypotheses were tested at a 95% confidence interval. The qualitative data from the four focus group discussions and 20 key informant interviews were thematically analysed using NVivo, a process that involved systematic coding, organisation, and retrieval of key patterns and insights from the transcripts. The study respondents comprised 726 patients with T2DM and 275 primary caregivers. The majority of the patients had lived with T2DM for over two years, were middle-aged, and had more than two adults living with them in their households. The primary caregivers, on average, were 43 years old, predominantly female, and had been supporting their patients for over three years. After six months of intervention, the primary caregivers' capacity in diabetes self-management practices and social support requirements, although statistically significant in both groups, improved by 27.2% in the experimental group compared to 7.6% in the control group. A linear regression analysis of the tangible, emotional and informational social support provided was statistically significant at a 95% confidence interval, B = 0.356 [95% CI: 0.086, 0.627], t = 2.586, p = 0.01, R2 = 0.137. A linear regression analysis on the difference-in-differences revealed that the change observed pre- and post-intervention implied a positive impact on the extent of tangible, emotional and informational social support received by T2DM patients, which is directly attributable to the intervention; B = 0.280 [95% CI: 0.064, 0.496], t = 2.545, p = 0.01. The impact was significant, F(3, 1462) = 56.289, p < 0.001, and explained 1.04% of the variation observed, R² = 0.104. This resulted in a statistically significant improvement in self-management practices among the T2DM patients at the experimental site, B = 0.140 [95% CI: 0.072, 0.208], t = 4.046, p < 0.001. The effect size was determined to be medium, Cohen's f = 0.40, indicating that the improved capacity of primary care givers was a significant predictor of diabetes self-care management among T2DM patients (β =-2.16, p<0.001), thereby supporting the study hypothesis. There is a need to structure policy to include the role played by primary caregivers in improving self-management among T2DM patients, while addressing health system barriers that impede T2DM patients’ ability to self-manage. Further investigation into the psychological effects of caregiving on primary caregivers of patients living with chronic illnesses should be conducted.