Abstract:
Globally, the prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing,
corresponding to a rise in diabetes related complications in Kenya. This study aimed
to enhance self-care practices among patients newly diagnosed with T2DM through a
patient-tailored activation intervention. An embedded mixed methods study using a
sequential explanatory design was conducted involving 124 newly diagnosed patients
recruited from two level 5 hospitals in Kenya. Purposive sampling method was used
to select the study areas; Muranga Level 5 hospital as the study group and Kiambu
Level 5 hospital as the control group. The study was conducted over one year in
three phases: a baseline survey, an implementation phase, and a post-intervention
evaluation phase. Quantitative data were collected using the Patient Activation
Measure®-13 (PAM®-13), and a modified Diabetes Self-Management Questionnaire
(DSMQ) and analyzed using Statistical Package for the Social Sciences (SPSS)
version 26. Qualitative data were collected through Focus Group Discussions
(FGDs), and Key Informant Interviews (KIIs), and analyzed using NVivo 13.
Quantitative data were analyzed using descriptive statistics, chi-square tests, binary
logistic regression, and paired sample t-tests, while qualitative data were thematically
analyzed and triangulated. Ethical approval was sought from Kenyatta University
Ethics Review Committee (KU-ERC). At baseline, low patient activation was
observed in 46 (74.2%) participants in the control group and 43 (69.4%) in the study
group, while poor self-care practices were recorded in 30 (48.4%) participants in the
control group and 39 (62.9%) in the study group, respectively. Four themes emerged
from the FGDs on patient-related factors influencing self-care practices. Institutionrelated factors were significantly associated with self-care practices, including health
education sessions (OR = 1.887; 95% CI: 1.591–2.238), and scheduled follow-up
visits (OR = 0.379; 95% CI: 0.183–0.786). In addition, two main thematic categories
emerged from the FGDs and KIIs: enablers and inhibitors. Findings from the
baseline survey informed the development and implementation of the patient-tailored
activation intervention in Phase II. Participants in the study group were then followed
for three months. Following the intervention, the study group registered a (9.74-fold)
significant increase in the mean activation scores from 54.05 (±7.866) at baseline to
63.79 (±15.51) at post-intervention (t (61) = 4.474, p < .001), representing a large
effect size (Cohen’s d = 0.80) while participants in the control group recorded a
decrease in their mean activation scores from 52.50 (±6.62) at baseline to
47.41(±47.41) at post-intervention (t (61) = -2.559, p=0.013), with a moderate
negative effect size (d = −0.46). Regarding, self-care practices the control group
registered no significant change at post-intervention 5.28 (SD±1.77) from baseline
5.08 (SD±1.22) (t (61) = -0.798, p = 0.428), with a small effect size (d = 0.13) while
the study group registered a statistically significant change at post-intervention 6.77
(SD±1.67) compared to the baseline scores 4.77 (SD±0.96) (t (61) = -8.229, p <
.001), corresponding to a very large effect size (d = 1.47). The findings demonstrate
that early patient-tailored activation significantly improves patient activation levels
and self-care practices among individuals newly diagnosed with T2DM. The study
therefore recommends that healthcare professionals adopt early patient
empowerment strategies to identify the needs of newly diagnosed patients and to
strengthen their confidence and skills in self-managing their condition.
