# Feasibility and impact of a patient support group care model on diabetes and hypertension care in informal settlements in Nairobi, Kenya: a quasi-experimental study

## TL;DR

A self-financing patient support group model improved diabetes and hypertension management in Nairobi's informal settlements over six months.

## Contribution

The study demonstrates the feasibility and effectiveness of a self-financing patient support group model in resource-limited settings.

## Key findings

- HbA1c decreased significantly more in the intervention group compared to the control group.
- Systolic blood pressure decreased in both groups, with a notable reduction in the intervention group.
- The model is feasible and can be adapted for managing other chronic diseases in low-resource settings.

## Abstract

A support group care model including self-financing is a promising strategy to improve care for patients with diabetes or hypertension in resource-constrained settings.

We investigated the uptake, feasibility, and impact of a self-financing patient support group care model on cardiometabolic parameters among adult patients with uncontrolled diabetes or hypertension in informal settlements in Nairobi, Kenya.

A two-group prospective quasi-experimental study was conducted. The outcomes were changes in mean glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, and waist–hip ratio in control versus intervention communities, assessed 6 months after intervention implementation.

At baseline, 118 patients with diabetes (intervention, 60; control, 58) and 176 with hypertension (intervention, 87; control, 89) were enrolled. At endline, 81 patients with diabetes and 137 with hypertension were surveyed. In the intervention arm, HbA1c decreased from 10.8% to 9.0% (mean difference [95% CI]: −1.7 [−2.4, −0.9] p < 0.001) and in the control arm from 10.6% to 9.9% (−0.9 [−1.5, −0.3] p = 0.005). Difference-in-difference analysis showed a notably greater reduction in HbA1c in the intervention arm (−0.942 [0.463] p < 0.05). In the intervention arm, SBP decreased from 155.0 mmHg to 148.7 mmHg (−6.3 [−11.7, -0.9] p = 0.022) and in the control arm, from 160.1 mmHg to 152.5 mmHg (−7.6 [−12.9, −2.3] p = 0.005). DBP in the intervention arm changed from 99.1 mmHg to 97.9 mmHg (−1.1 [4.2, 1.9] p = 0.462) and in the control arm from 99.7 mmHg to 94.8 mmHg (−4.9 [7.8, −2.0] p = 0.001).

A self-financing patient support group care model is feasible, improves cardiometabolic parameters and can be a strategy to manage diabetes, hypertension, and other chronic diseases in low-resource settings.

Main findings: A co-created self-financing patient support group care model tested for 6 months among patients with uncontrolled diabetes or hypertension in informal settlements in Nairobi, Kenya, resulted in substantial reductions in glycated haemoglobin and blood pressure.Added knowledge: A self-financing patient support group care model for diabetes and hypertension is feasible and can impact disease outcomes in low-resource settings.Global health impact for policy and action: The self-financing patient support group care model is an additional toolkit to manage diabetes and hypertension in resource-limited settings and can be adapted for other chronic diseases.

Main findings: A co-created self-financing patient support group care model tested for 6 months among patients with uncontrolled diabetes or hypertension in informal settlements in Nairobi, Kenya, resulted in substantial reductions in glycated haemoglobin and blood pressure.

Added knowledge: A self-financing patient support group care model for diabetes and hypertension is feasible and can impact disease outcomes in low-resource settings.

Global health impact for policy and action: The self-financing patient support group care model is an additional toolkit to manage diabetes and hypertension in resource-limited settings and can be adapted for other chronic diseases.