Lay Health Worker Led Diabetes Task-Sharing Intervention in Middle-Income Countries: A Systematic Review and Meta-Analysis
Abstract
Background: Task-sharing in diabetes management may be useful for health systems in staff- and resource-poor middle-income countries. The study evaluated the effectiveness of a task-sharing intervention for diabetes led by non-professional health workers in improving glycaemic indicators and blood pressure among adults in middle-income countries.
Methods: Embase, PubMed, MEDLINE and Cochrane Central Registry of Controlled Trials were searched for studies published from 2010-2022. Intervention studies involving task-sharing strategies for managing diabetes and other cardiovascular risk factors were included. Extracts were made on populations, interventions, and lay health worker training and supervision. The quality of studies was assessed using the Cochrane Risk of Bias tool. Performed a meta-analysis of randomised controlled trials. A random-effects model was used due to significant heterogeneity among the studies (I² ≥ 50%), otherwise, a fixed-effect model was used.
Results: Thirteen randomised controlled trials with 8183 patients were included in the meta-analysis. The population average pooled mean difference in HbA1c was -0.17% (95% CI -0.34 to -0.01) and in fasting blood glucose was -0.75 mmol/L (95% CI -1.14 to -0.35). The population average pooled mean difference in systolic blood pressure was -5.90 mmHg (95% CI -8.11 to -3.68) and in diastolic blood pressure was -2.25 mmHg (95% CI -3.10 to -1.40).
Conclusion: Task-sharing interventions for diabetes led by lay health workers in middle-income countries have shown potential for lowering blood glucose levels and reducing blood pressure.
2. Manne-Goehler J, Geldsetzer P, Agoudavi K, et al (2019). Health System Perfor-mance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally rep-resentative surveys. PLoS Med, 16 (3): e1002751.
3. Association AD (2019). Improving care and promoting health in populations: stand-ards of medical care in diabetes. Diabetes Care, 43 (Supplement_1): S7-S12.
4. Anand TN, Joseph LM, Geetha AV, et al (2019). Task sharing with non-physician health-care workers for management of blood pressure in low-income and mid-dle-income countries: A systematic re-view and meta-analysis. Lancet Glob Health, 7 (6): e761-e771.
5. Joshi R, Alim M, Kengne AP, et al (2014). Task shifting for Non-Communicable Disease Management in low- and mid-dle-income countries - a systematic re-view. PLoS ONE, 9 (8): e103754.
6. Maier CB, Aiken LH (2016). Task shifting from physicians to nurses in primary care in 39 countries: A cross-country comparative study. Eur J Public Health, 26 (6): 927 -934.
7. Maria JL, Anand TN, Dona B, et al (2021). Task-sharing interventions for improv-ing control of diabetes in low-income and middle-income countries: A system-atic review and meta-analysis. Lancet Glob Health, 9 (2): e170-e180.
8. Palmas W, March D, Darakjy S, et al (2015). Community Health worker interventions to improve glycemic control in people with diabetes: A systematic review and meta-analysis. J Gen Intern Med, 30 (7): 1004 -1012.
9. Little TV, Wang ML, Castro EM, et al (2014). Community Health Worker In-terventions for latinos with type 2 diabe-tes: A systematic review of randomized controlled trials. Curr Diab Rep, 14 (12): 558.
10. Werfalli M, Raubenheimer PJ, Engel M, et al (2020). The effectiveness of peer and community health worker-led self-management support programs for im-proving diabetes health-related out-comes in adults in low- and-middle-income countries: A systematic review. Syst Rev, 9 (1): 133.
11. Chao J, Yang L, Xu H, et al (2015). The ef-fect of Integrated Health Management Model on the health of older adults with diabetes in a randomized controlled tri-al. Arch Gerontol Geriatr, 60 (1): 82 -8.
12. Mash RJ, Rhode H, Zwarenstein M, et al (2014). Effectiveness of a group Diabe-tes Education Programme in under‐served communities in South Africa: A pragmatic cluster randomized con-trolled trial. Diabetic Med, 31(8): 987-93.
13. Ju C, Shi R, Yao L, et al (2018). Effect of peer support on diabetes distress: A clus-ter randomized controlled trial. Diabetic Med, 35 (6): 770-775.
14. Debussche X, Besançon S, Balcou-Debussche M, et al (2018). Structured peer-led diabetes self-management and support in a low-income country: The ST2EP randomised controlled trial in Mali. PLOS ONE, 13 (1): e0191262.
15. Browning C, Chapman A, Yang H, et al (2016). Management of type 2 diabetes in China: The happy life club, a prag-matic cluster randomised controlled tri-al using health coaches. BMJ Open, 6 (3): e009319.
16. de Souza CF, Dalzochio MB, Zucatti ATN, et al (2017). Efficacy of an education course delivered to community health workers in diabetes control: A random-ized clinical trial. Endocrine, 57(2): 280-286.
17. DePue JD, Dunsiger S, Seiden AD, et al (2013). Nurse -Community Health Work-er team improves diabetes care in American Samoa. Diabetes Care, 36 (7): 1947-53.
18. Zhong X, Wang Z, Fisher EB, et al (2015). Peer support for diabetes management in primary care and community settings in Anhui Province, China. Ann Fam Med, 13 (Suppl_1): S50-8.
19. Yin Z, Perry J, Duan X, et al (2018). Cultur-al adaptation of an evidence-based life-style intervention for diabetes preven-tion in Chinese women at risk for diabe-tes: Results of a randomized trial. Int Health, 10 (5): 391-400.
20. Deng K, Ren Y, Luo Z, et al (2016). Peer support training improved the glycemic control, insulin management, and dia-betic behaviors of patients with type 2 diabetes in rural communities of Central China: A randomized controlled trial. Med Sci Monit, 22: 267-75.
21. Wijesuriya M, Fountoulakis N, Guess N, et al (2017). A pragmatic lifestyle modifica-tion programme reduces the incidence of predictors of cardio-metabolic dis-ease and dysglycaemia in a young healthy urban South Asian population: A randomised controlled trial. BMC Med, 15 (1): 146.
22. Paz-Pacheco E, Sandoval MA, Ardena GJ, et al (2017). Effectiveness of a communi-ty-based diabetes self-management edu-cation (DSME) program in a rural agri-cultural setting. Prim Health Care Res Dev, 18 (01): 35 -49.
23. Khetan A, Zullo M, Rani A, et al (2019). Ef-fect of a community health worker-based approach to Integrated trial. Glob Heart, 14 (4): 355-365.
24. Browning CJ, Yang H, Zhang T, et al (2015). Implementing a chronic disease self-management program into china: the happy life club™. Front Public Health, 2: 181.
25. Ajay VS, Jindal D, Roy A, et al (2016). De-velopment of a smartphone‐enabled hypertension and diabetes mellitus management package to facilitate evi-dence‐based care delivery in primary healthcare facilities in India: The mPower Heart Project. J Am Heart Assoc, 5 (12): e004343.
26. Mbuthia GW, Magutah K, Pellowski J (2022). Approaches and outcomes of Community Health Worker’s interven-tions for hypertension management and control in low-income and middle-income countries: Systematic Review. BMJ Open, 12 (4): e053455.
27. Blonde L, Umpierrez GE, Reddy SS, et al (2022). American Association of Clinical Endocrinology Clinical Practice Guide-line: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract, 28 (10): 923-1049.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19567 | |
| Keywords | ||
| Diabetes Task-sharing intervention Non-professional health workers Meta-analysis | ||
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