The Process Evaluation of a Comparative Controlled Trial to Support Self-management for the Prevention and Management of Type 2 Diabetes in Uganda, South Africa and Sweden in the SMART2D Project.
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy
lifestyle and self-management is paramount, but not adequately implemented in health systems in most
countries. Process evaluations facilitate understanding why and how interventions work through
analysing the interaction between intervention theory, implementation and context. The SMART2D project
implemented and evaluated community-based support interventions for persons at high risk of or having
T2D in a rural community in Uganda, an urban township in South Africa, and socio-economically
disadvantaged urban communities in Sweden. This study presents comprehensive analyses of the
implementation process and interaction with context.
Methods. This paper reports implementation process outcomes across the three sites, guided by the MRC
framework for complex intervention process evaluations and focusing on the three community strategies
(peer support program; care companion; and link between facility care and community support). Data
were collected through observations of peer support group meetings using a structured guide, and semistructured
interviews with project managers, implementers and participants.
Results. The countries focused their in-depth implementation in accordance with the feasibility and
relevance in the context. In Uganda and Sweden, the implementation focused on the peer support
intervention whereas in South Africa, it centred around the CC part. The community-facility link received
the least attention in the implementation. Continuous capacity building received a lot of attention, but
intervention reach, dose delivered and fidelity varied substantially. Intervention- and context-related
barriers affected participation. The analysis revealed how context shaped the possibilities of
implementation, the delivery and participation and affected the mechanism of impact.
Conclusions. Identification of the key uncertainties and conditions facilitates focus and efficient use of
resources in process evaluations, and context relevant findings. The use of an overarching framework
allows to collect cross-contextual evidence and a flexibility in evaluation design to adapt to the complex
nature of the intervention. When designing an intervention, it is crucial to consider aspects of the
implementing organization or structure, absorptive capacity, and to thoroughly assess and discuss
implementation feasibility, capacity and organizational context with the implementation team and
recipients. These recommendations are important for implementation and scale up.
Description
Keywords
Type 2 diabetes, Prevention, Self-Management, Peer support, Disadvantaged settings, Reciprocal learning, Process evaluation, Low & Middle Income countries, Implementation research, Community interventions
Citation
van Olmen, J., Absetz, P., Mayega, R. W., Timm, L., Delobelle, P., Molsted-Alvesson, H., ... & Daivadanam, M. (2021). The Process Evaluation of a Comparative Controlled Trial to Support Self-management for the Prevention and Management of Type 2 Diabetes in Uganda, South Africa and Sweden in the SMART2D Project. https://doi.org/10.21203/rs.3.rs-581101/v1