SMART2D—development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Translational Behavioral Medicine,
Abstract
Type 2 diabetes (T2D) and its complications are increasing
rapidly in low- and middle-income countries, as well as among
socioeconomically disadvantaged populations in high-income
countries. Support for healthy lifestyle and self-management
is paramount but not well implemented in health systems, and
there is need for knowledge on how to design and implement
interventions that are contextualized and patient centered and
address special needs of disadvantaged population groups.
The SMART2D project implements and evaluates a lifestyle
and self-management intervention for participants recently
diagnosed with or being at increased risk for T2D in rural
communities in Uganda, an urban township in South Africa,
and socioeconomically disadvantaged urban communities in
Sweden. Our aim was to develop an intervention with shared
key functions and a good fit with the local context, needs, and
resources. The intervention program design was conducted in
three steps facilitated by a coordinating team: (a) situational
analysis based on the SMART2D Self-Management Framework
and definition of intervention objectives and core strategies; (b)
designing generic tools for the strategies; and (c) contextual
translation of the generic tools and their delivery. This article
focuses on community strategies to strengthen support from
the social and physical environment and to link health care and
community support. Situational analyses showed that objectives
and key functions addressing mediators from the SMART2D
framework could be shared. Generic tools ensured retaining of
functions, while content and delivery were highly contextualized.
Phased, collaborative approach and theoretical framework
ensured that key functions were not lost in contextualization,
also allowing for cross-comparison despite flexibility with
other aspects of the intervention between the sites.
Description
Keywords
Type 2 diabetes, Prevention, Self-management, Peer support, Disadvantaged settings, Reciprocal learning
Citation
Absetz, P., Van Olmen, J., Guwatudde, D., Puoane, T., Alvesson, H. M., Delobelle, P., ... & Daivadanam, M. (2020). SMART2D—development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden. Translational Behavioral Medicine, 10(1), 25-34. doi: 10.1093/tbm/ibz188