Potential for behaviour change among Kenyan type 2 diabetes service users and to understand behaviour change from healthcare professionals’ perspectives

Abstract

Introduction: The rising type two diabetes mellitus (T2DM) prevalence is largely due to unhealthy dietary practices, lack of physical activity, economic development, urbanisation, and an ageing population. Management of T2DM involves pharmacological treatment and or lifestyle behaviour changes focusing on diet and physical activity behaviour modifications. Diet and physical activity behaviour modifications are crucial in T2DM management. However, behaviour change is complex and challenging and more so in diet and physical activity behaviours as these are influenced by a myriad of behavioural, social, emotional and environmental, neuroendocrine and genetic factors. Behaviour change thus remains one of the most significant public health concerns. Underpinning this research study is the continued challenge with behaviour change among T2DM service users that leads to development of T2DM related complications and even death. The purpose of this study was therefore to examine the likelihood to change behaviour so as to avoid T2DM related complications and to explore whether being in receipt of the recommended care services had any influence on likelihood to change behaviour. This is particularly important because numerous interventions have been carried out but while change may be initially noted, the positive behaviour is in many cases not sustained over time. The main impact of this study to provide an understanding on the influences of behaviour change as influenced by the health belief model and to explore hinderances to access to the diabetes recommended care services. Methods: The study utilised a mixed-method approach to gain an in-depth comprehension of the topic. The target population for the study comprised of T2DM service users at the Thika Level 5 Hospital diabetes comprehensive clinic and healthcare professionals directly involved in T2DM management. Through power calculations, a sample size of 346 service users was determined. Forty three healthcare professionals were also included in the study as key informants. The inclusion criterion for the diabetes clinic service users was persons diagnosed with type two diabetes and aged 20-70. The inclusion criterion for the healthcare professionals was those who directly worked with service users with regards to behaviour change. Purposive sampling was used in selecting the participants for the study. The exclusion criterion for the service users was those who had type one diabetes or were aged below 20 or above 70 years. For the healthcare professionals, those not directly involved with type two diabetes service users behaviour change (diet and physical activity) were not included in the study. Questionnaires were used to collect quantitative data from the service users. Semi-structured individual interviews were used to collect data from the healthcare professionals. Quantitative data was coded and entered into the Statistical Package for Social Sciences, Version 28.0, for analysis. Qualitative data was entered into Nvivo 13 for thematic analysis. Findings: Behaviour change among healthcare professionals and T2DM service users is based on four constructs of the health belief model: susceptibility to complications, intention to exercise, perceived benefits of exercise and health eating and healthy eating intentions (likened to cues to action). Different factors that affect T2DM management are categorised into predisposing factors, reinforcing factors and enabling factors. Management processes of T2DM should include primary targets to prevent T2DM, primary targets towards promoting behaviour change, actions engaged in the management of T2DM, multi-sectorial approaches and actions by other sectors. Conclusion: According to the study, behaviour change is perceived differently among healthcare professionals and service users. The study therefore recommends that tailored messages should be delivered to different categories of patients so as to enhance behaviour change. The health belief model should be adopted in crafting the messages so as to so as to effectively address complications (perceived susceptibility and severity) associated with T2DM, perceived barriers, perceived benefits, and self-efficacy for behaviour change to be effective. A “one size fits all” approach is not recommended when coming up with interventions towards behaviour change. Further, the study also concludes that policy makers in the Kenyan health system should consider predisposing factors, reinforcing factors and enabling factors towards T2DM management policy making. Since T2DM management involves different targets, the Kenyan health system should engage different stakeholders. A “one size fits all” approach is therefore not appropriate towards T2DM management.