Can community-based health clubs improve chances for people with diabetes?

The THET Nursing Fellowship, in partnership with the Nursing Now Challenge, has supported over 100 early-career nurses and midwives in Africa and Asia to undertake dedicated training in leadership and quality improvement (QI) projects in their local communities.  

Nursing Now Fellow Lubega Martin, 29, currently Education, Training and Registration Officer at Uganda Nurses and Midwives Council, discusses his 2023 QI project and how it led to the publication of Uganda’s first-ever article on diabetes care in the British Medical Journal. 

“My chosen QI project trialled community-based health clubs to improve self-care management for people with diabetes. I chose this topic as I had been particularly interested in diabetes since my internship days at Soroti Regional Referral Hospital in 2019, during which time I saw many challenges in educating people about the condition. For example, low staff numbers meant there was little time to spend on awareness-raising, and patients were often in a rush anyway, having left their children at home or needing to go to work. Most patients had complications that would have been prevented or delayed if they had known they could make basic lifestyle changes and monitor their condition on an ongoing basis. 

I had previously tried to solve this riddle by writing a patient handbook, which was approved by the Ministry of Health and went on general sale. It was popular, and it showed people were eager to get information on diabetes self-care management. But it was only available in English, so I was looking for a better way of reaching people in their local language. So when I was selected for the Nursing Now Fellowship, I already had something burning in me: find a way to reach people in a more dynamic way than the handbook I had written. 

The community-based health club model 

I knew I wanted to trial a method specifically focused on health, education and empowering patients, one that gave patients the opportunity to interact and share with each other. I also wanted to give enough time between the nurse educator and the patient to make it worthwhile. I had previously read about community-based health clubs and how they had been used to support patients with other chronic diseases, and I decided to test if this could be the answer.  

I selected two nursing students from the Department of Nursing at Makerere University College of Medicine, and trained them using my handbook and the Uganda Clinical Guidelines on diabetes care. As a team, we then approached patients seeking diabetes services at Wakiso Health Centre IV, to identify those who lived in two selected villages and ask them if they wanted to join the project. It was important throughout that the process be community-led, with patients deciding when and where they wanted the clubs to take place. We then established two clubs holding weekly sessions over an eight-week period. Each meeting had an average of 15 participants. 

When we arrived in the communities we would bring branded items including t-shirts and banners, so that if there were any people with diabeties who had not been selected, they would know they could come and join us. Each week we discussed topics such as medication, lifestyle, nutrition etc. We also did free blood sugar testing and measured blood pressure and other vitals. We connected patients with an ophthalmologist in the local hospital and everyone benefitted from an eye check. 

At the end of the programme we held focus group discussions, where we received really positive feedback. Many patients praised the clubs for the amount of time they got to spend with health workers. The opportunity to share stories with others in a similar situation changed people’s whole experience of the disease. For example, one woman shared that she had had diabetes for 10 years, but none of her family knew. She had been scared of telling them, but now was encouraged by others in her group to do so. 

Thanks to THET and the Burdett Trust for the financial support I received for the project, and from Dr Scovia Mbalinda who mentored us throughout the Nursing Now Fellowship, we were supported to publish a paper on this work in the British Medical Journal. I am extremely proud that this is not only the first paper from Uganda on this subject, it is the first from the whole of sub-Saharan Africa. This is a great achievement and has led to many opportunities for me – for instance I was invited to present at the 43rd World Nursing and Healthcare Conference in London in August 2024. The fact I could speak about a nurse-led quality improvement project to so many healthcare professionals was very exciting for me. 

Future opportunities 

I think this project was successful because we fully engaged patients in its design. We were also blessed that we went to a community that was really welcoming and very eager to receive us. Looking forward, I am keen to find ways to scale-up the project and replicate its success.  

For example, I am confident that some group members could actually become Champions. I know they can, because one patient went on to lead another community to develop their own club and is already giving health talks. So, the angle of empowering patient Champions can help spread this work to other communities and make it self-sustaining. That is something I am keen to test as soon as possible.”