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Open Access Research article

Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial

Shengsheng Liu1, Anhua Bi1, Dongbo Fu2*, Hua Fu2, Wei Luo1, Xiaoying Ma3 and Liyan Zhuang4

Author affiliations

1 Songjiang District Centre for Disease Prevention and Control, 1050 North Xi Lin Road, Shanghai, 201620, China

2 Department of Preventive Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 20032, China

3 Fangsong Community Health Centre, Shanghai, China

4 Zhongshan Community Health Centre, Shanghai, China

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Citation and License

BMC Public Health 2012, 12:1043  doi:10.1186/1471-2458-12-1043

Published: 3 December 2012

Abstract

Background

Diabetes has become a major public health problem in China. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes. A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai. This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai.

Methods

208 patients with type 2 diabetes aged 35–80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. The trial was undertaken in two rural communities in Shanghai, China. Randomization and allocation to study group were carried out by using a random number table. Analysis of covariance was used to compare changes in the 17 self-management behavior, self-efficacy and health status related variables in two groups at 12 months’ follow-up based on 176 patients (n=98; n=78).

Results

Compared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6% of them attended 10 and more sessions.

Conclusion

The Chinese diabetes group visit model is a feasible, acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities. The model requires larger studies to determine its effect on blood glucose control and health care utilization.

Trial registration

ISRCTN87909028

Keywords:
Diabetes; Group visits; Self-management; Community health services; Randomized controlled trials; China