Effectiveness of a Community-Based, Peer-Led, Literacy-Sensitive Diabetes Self-Management Education Program among Low-Literacy Adults with Type 2 Diabetes: A Non-Randomized Mixed-Methods Field Trial

Saranya Rajamanickam; Vijaykumar Rajendran; Surekha A; Suguna A; Rock Britto

doi:10.55489/njcm.170520262545

Authors

Saranya Rajamanickam Sri Balaji Vidyapeeth (Deemed to be University), Pondicherry; Department of Community Medicine, Swami Vivekanandha Medical College Hospital and Research Institute, Tiruchengode, India
Vijaykumar Rajendran Department of Community Medicine, Swami Vivekanandha Medical College Hospital and Research Institute, Tiruchengode, India
Surekha A Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Chennai, India
Suguna A Department of Community Medicine, Trichy SRM, Medical College and Research Institute, Trichy, Tamil Nadu, India
Rock Britto Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Research Institute, Trichy, Tamil Nadu, India

DOI:

https://doi.org/10.55489/njcm.170520262545

Keywords:

Type 2 diabetes, DSME, Peer education, Low literacy, Health literacy

Abstract

Background: Peer-led and literacy-sensitive diabetes self-management education (DSME) has shown promise in improving outcomes among underserved populations with low literacy. The objective was to assess the observed effectiveness of a peer-led, literacy-sensitive DSME program on glycemic control and self-management behaviors among low-literate adults with type 2 diabetes.

Methods: An explanatory sequential mixed-methods design was employed. In the quantitative phase, 160 adults with type 2 diabetes participated in a non-randomized controlled field trial conducted in community settings, with service-based allocation to intervention (n = 80) and usual care (n = 80). HbA1c was the primary outcome. Self-care behaviors, diabetes knowledge, and body mass index were secondary outcomes assessed at baseline and six months. Analysis of covariance and multivariable linear regression were applied.

Results: At six months, the intervention group showed a greater reduction in HbA1c compared with usual care (adjusted mean difference -0.60%, 95% CI -0.95 to -0.25). Improvements in self-care behaviors and diabetes knowledge were also observed. Qualitative findings indicated that spoken and visual learning, teach-back, shared experiences, and peer accountability supported behavior change.

Conclusion: The findings suggest that peer-led, literacy-sensitive DSME is associated with improved diabetes-related outcomes among low-literate adults when implemented under real-world community conditions.

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