EFFECTIVENESS OF PEER SUPPORT ON FOOT SELF-CARE PRACTICES FOR PREVENTION OF FOOT COMPLICATIONS AMONG PATIENTS WITH DIABETIC MELLITUS IN WESTERN KENYA

Abstract

Individuals with chronic conditions such as diabetes need assistance in learning, mastering and sustaining complex self-care practices that support healthy living and prevent development of complications. Peer support is an effective and cost friendly intervention in self-management of chronic health conditions. Despite numerous literature showing evidence that peer support has benefits if implemented, its effectiveness on foot self-care practices among diabetic patients remains variable with very few studies documenting its use. This study sought to determine the effectiveness of peer support on foot self-care practices for prevention of foot complications among diabetic patients in Western Kenya. This was achieved by assessing performance of foot self-care practices, examining the factors influencing peer support and analyzing the outcome of peer support strategies in foot self-care practices with the aim proposing a peer support framework that will promote foot self-care practices among diabetes patients in Western Kenya. The study’s underlying theoretical model was social support theory by Don Drennon-Gala and Francis Cullen that describe the forms of support required to sustain healthy behavior and prevent complications in chronic illnesses. This was a quasi-experimental non-equivalent post-test only study that utilized bot quantitative and qualitative approaches. Target population was diabetic patients in sampled hospitals in western Kenya. Questionnaires, focused group discussions and key informant interviews were utilized to collect data. Sampled participants were put in two groups with one being the intervention group while the other the control group. Ethical considerations were adhered to accordingly. Quantitative data was analyzed using measures of central tendency and dispersion. Relationships were elicited using ANOVA and regression analysis between and within variables. Qualitative data was analyzed thematically. The mean age of participants was 51.7±10.9 years. Majority of the participants were females (55.2%), had attained secondary level of education (44%), were employed (362%), married (72.4%), had no comorbidities (71.6%), had type two diabetes (62.9%) and had diabetes for more than 10 years (56.9%). The mean foot self-care practices score was notably higher in the intervention group at 61.1 (95% CI: 59.5 - 62.8) compared to control group at 35.7 (95% CI: 34.2 - 37.1) with a significant P value of <0.001 and a substantial partial Eta2 of 0.84. Instrumental support (P-value 0.034), Informational support (P- value 0.04), appraisal support (P- value 0.008), level of education (P-value 0.048) and employment status (P-value 0.013) significantly influenced effectiveness of peer support. Improved coping, emotional resilience, emotional connection and understanding, dependable support, helpful support and increased confidence were amongst the outcomes of the peer support strategies. The PEER-CARE framework, derived from the study, presents a structured approach for implementing peer support in foot self-care among diabetics. The study therefore concluded that peer support is effective in improving foot self- care practices among diabetes patients and further recommends that healthcare providers should incorporate structured peer support in their daily management of patients with diabetes based on the proposed peer-care framework. Regular evaluations of the framework's impact on diabetes management and prevention of diabetic foot complications can inform ongoing improvements and adaptations. Information dissemination will be done in relevant forums including conference presentations and publications.