Utilization of Patient-activation Intervention to Enhance Self-care Practices among Patients Newly Diagnosed with Type 2 Diabetes Mellitus in Selected Hospitals, Kenya

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.