The ability of health promoters to deliver group diabetes education in South African primary care

BACKGROUND: Diabetes makes a significant contribution to the burden of disease in South Africa. This study assesses a group diabetes education programme using motivational interviewing in public sector health centres serving low socio-economic communities in Cape Town. The programme was delivered by mid-level health promotion officers (HPOs). OBJECTIVES: The aim of the study was to explore the experience of the HPOs and to observe their fidelity to the educational programme. METHODS: Three focus group interviews were held with the 14 HPOs who delivered the educational programme in 17 health centres. Thirty-three sessions were observed directly and the audio tapes were analysed using the motivational interviewing (MI) integrity code. RESULTS: The HPOs felt confident in their ability to deliver group education after receiving the training. They reported a significant shift in their communication style and skills. They felt the new approach was feasible and better than before. The resource material was found to be relevant, understandable and useful. The HPOs struggled with poor patient attendance and a lack of suitable space at the facilities. They delivered the majority of the content and achieved beginning-level proficiency in the MI guiding style of communication and the use of open questions. The HPOs did not demonstrate proficiency in active listening and continued to offer some unsolicited advice. CONCLUSION: The HPOs demonstrated their potential to deliver group diabetes education despite issues that should be addressed in future training and the district health services. The findings will help with the interpretation of results from a randomised controlled trial evaluating the effectiveness of the education.