Key result
The self-financing patient support group care model reduced mean HbA1c significantly more than standard of care (difference-in-difference -0.942%, p<0.05), but did not significantly improve blood pressure.
Why the study?
A self-financing patient support group care model is a promising strategy to improve care for patients with diabetes or hypertension in resource-constrained settings.
Does a self-financing patient support group care model improve blood pressure and HbA1c in adults with uncontrolled hypertension or diabetes in resource-constrained settings?
Cohort (n=294)
Cluster allocation by lottery
Does a self-financing patient support group care model improve blood pressure and HbA1c in adults with uncontrolled hypertension or diabetes in resource-constrained settings?
Mean Difference: -0.942
Absolute Event Rate: -1.7% vs -0.9%
p-value: p=<0.05
A self-financing patient support group model is feasible in low-resource settings and significantly improves glycaemic control, though longer durations may be needed to achieve measurable blood pressure improvements.
Was associated with greater HbA1c reduction in low-resource diabetes; hypothesis-generating and requires RCTs before practice change.
Background 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.Objectives 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.Methods 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.Results 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).Conclusions 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.
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Sanya et al. (2025) conducted a cohort in Uncontrolled diabetes or hypertension (n=294). Self-financing patient support group care model vs. Standard of care was evaluated on Change in mean HbA1c at 6 months (Difference-in-difference -0.942, p=<0.05). The self-financing patient support group care model reduced mean HbA1c significantly more than standard of care (difference-in-difference -0.942%, p<0.05), but did not significantly improve blood pressure.
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