Discussion
T2D, diabetes
DIABETES
The study found that the DSMES programme intervention had favourable effects on improving the support needed and the support received, with medium to large effect sizes amongst people with diabetes in Western Ethiopia. Support needed and support received were increased but eventually decreased with respect to support attitudes in the intervention group compared with those in the control group. Similarly, the family caregiver’s supportive behaviour was enhanced over the study periods, but more non-supportive behaviours were observed only during the follow-up.The preliminary DSMES programme significantly improved the support needed and received outcomes compared with the usual care. The main possible reason for better support needed and received from friends or families was the involvement of family caregivers in the intervention. According to SCT, family support is an environmental factor that influences personal behaviours. The support seeking behaviour of people with diabetes may be increased because the family caregivers co-attended the intervention and set a goal together, which may give them intimacy about diabetes and its management. A finding from a systematic review that included 23 studies to see the effect of family support on diabetes outcomes amongst people with T2D showed a positive outcome on perceived supportThe families obtained a healthy diet for a person with diabetes and the technique of food estimation. Their diabetes knowledge might have been increased by observation and experience sharing on diabetes self-management (DSM). A previous study reported that DSM education improved social support statusIn contrast, the DSMES programme has not effectively improved the support attitudes in the intervention group compared with the usual care. Verbal persuasion and increased behavioural capacity were designed to boost the support attitudes. A community-based study implementing DSM education intervention found that intervention was ineffective compared with usual careThe DSMES programme produced positive and significant results in terms of the family caregiver’s supportive behaviour over the study period between the two groups. This finding is similar with mobile app delivered family supported self-management interventionThe RCT conducted in Jimma University Medical Centre, Ethiopia, reported that DSM education was successful in increasing diabetes knowledgeOn the other hand, the family caregivers in the intervention group held non-supportive behaviours at T1 than the usual care. This is also consistent with previous studyUsing validated diabetes specific scales to measure the outcomes is one of the strengths of the study. As the study was a pilot study, it can only provide a preliminary result, which needs a full scale RCT to ensure the effects of DSMES programme on the support behaviour of the dyads. Translation and psychometric testing of the scales were done on the target population which resulted in some modifications in the DFBC scale, further testing of the modified Afaan-Oromoo version of the DFBC scale are needed to examine the cultural adaptation in the Ethiopian population. In addition, the study did not address the qualitative study to see the intervention acceptability and there was a potential for information contamination as the pilot was conducted in one hospital and nearby community.