Date of Award

2-2025

Degree Type

Thesis

Degree Name

Master of Science in Advanced Practice Nurs​ing (MSc-APN)​

First Advisor

Dr. Rachel Kimani

Second Advisor

Dr. Rose Maina

Department

School of Nursing and Midwifery, East Africa

Abstract

Background: Type 2 Diabetes (T2DM) has placed a significant burden on both healthcare systems and individuals living with the disease. However, it is preventable through health promotion strategies. Healthy behavior changes, which improve disease outcomes, highlight the importance of supporting and sustaining self-efficacy in diabetes self-management.

Objective: This study aimed to test the effectiveness of a nurse-led health coaching program on diabetes control for individuals with T2DM with HbA1c >6.5% specifically on glycated haemoglobin (HbA1c) levels as compared with standard diabetes care only.

Methodology: The study adopted a randomized controlled trial (RCT) with two groups: an intervention group receiving the nurse-led health coaching program and a control group receiving standard diabetes care. Participants included individuals living with T2DM, aged 18 years and above, who were enrolled at the diabetic outpatient clinic at AKUH-N. The primary outcome measured was the change in glycated hemoglobin (HbA1c). Data were assessed at baseline (0 months), 3 months, and 6 months. Data were entered into SPSS version 20, with baseline and post-assessments analyzed using ANCOVA. Chi-square tests and t-tests were used to assess differences in HbA1c and self-efficacy between the two groups.

Results: Out of 160 eligible T2DM patients, the consenting 134 participants were randomized into intervention and control groups where 14 were lost to follow-up with only 120 participants (n= 68 intervention and n= 52 control group) completing the study. Regarding baseline health characteristics, the intervention group had a significantly higher mean HbA1c level (10.3172 ±2.86) compared to the control group (8.7369 ±2.39), p=.001, while there was no significant difference in average systolic BP, diastolic BP (132.32±18.004), total cholesterol (4.805 ±1.41 vs 4.801±1.16, p=.494) and BMI (28.518±3.38 vs 29.462±5.03, p=.111) in the intervention group. Similarly, there was no significant difference in medication adherence (MMAS scale) and the average self-efficacy (PDSMS Scale) (25.85±4.39) in both groups, though health management (23.17±5.12) in the intervention were higher as compared to the control. Further, the analysis indicated no significant differences in regular physical activity, healthy diet, and sleep patterns between the intervention and the control group though 25% of the participants in the intervention group and 34.6% in the control group reported regular physical activity. Concerning glycemic control, the study findings showed that the average HbA1c levels after 6 months significantly decreased (7.36±1.512) compared to baseline and after 3 months, (p=.001). Additionally, cardiovascular risk factors such as systolic BP (74.04±7.887, p=0.045), diastolic BP (F=4.643, η2=0.033, p=.033), and BMI (27.27±3.95 vs 28.78±4.258, p=.034) improved significantly after six months.

Recommendations: This study recommends that future programs incorporate more intensive, tailored nurse-led education approaches to realize meaningful changes in well being behaviours among individuals with type II diabetes. Health coaching can be integrated with diabetes care to help individuals living with the disease influence health behaviour modification.

Conclusion: Nurse-led health coaching is an effective preventive intervention with local evidence of targeting modifiable lifestyle factors and improving T2DM self-management health behaviours to achieve glycemic control. It also has a promising benefit in improving other clinical health outcomes (cardiovascular risk factors) among T2DM; hence, it can be implemented to reduce the rising burden of T2DM in Kenya.

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1

Last Page

119

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