Diabetes Literacy

Seventh Framework Programme European Commission

Thesis on Self-Management Education in South Africa


    One of the collaborating partners in the Diabetes Literacy project was the University of Pretoria in South Africa. This collaboration resulted in the thesis of researcher Loveness Dube on "Self-management education for patients with chronic diseases. Educational approaches and conditions for effective implementation”, defended at the Université catholique de Louvain on February 17, 2017.

    Motivation. The motivation for the thesis is that - although self-management is regarded as a key component of care for people with chronic diseases, especially in resource-limited settings - to date, most self-management education  (SME) has been implemented in high-income countries. To address this, the thesis  focuses on SME for chronic disease patients in a developing country: South Africa.

    Elements. First, a systematic review was performed of the literature on diabetes self-management education (DSME) programs in developing countries. Second, an audit of policies on DSME education for patients in South Africa was performed.  In total 27 DSME programs could be identified, mostly mixed with interventions for other chronic diseases. A third question focused on the SME needs of chronic disease patients in South Africa. The next question addressed the feasibility of implementing a contextually adapted SME support tool. The last part of the study addressed the effect of using the tool for diabetes and hypertension patients.

    Conclusions. The research highlights a need for locally-based country research capacity building in low- and middle-income countries, as well as the implementation of SME programs that are tailored to the context and needs of the target population. As most funding to implement programs in developing countries related to the chronic disease burden is donor-funded, an intervention was developed that should be sustainable. The pilot test of the SME tool showed a considerable increase of knowledge for hypertension patient. However for diabetes patients and for changes in health literacy the study showed limited effects. Probably, the short time span was related to this result, as changes in health literacy needs time In discussing the main findings, attention is raised for the type of providers of SME programs. Professional staff should be wisely used in resource-limited settings and trained non-professionals should be included. On the other hand, this poses challenges. For example, community health workers could be overburdened and they should be trained and supported if they are to be involved in NCD care.  The thesis also points to challenges in the implementation of patient-centered care in the context of South Africa’s public healthcare, working with with a population characterized by low health literacy and the need of using low-cost interventions.


    Diabetes Literacy (www.diabetesliteracy.eu) is a pan European project aimed at strengthening patient self-management by exploring what exists and works, as well as the potential for improvement. The Diabetes Literacy project (2012/2015) received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration. The project has been implemented by a Consortium of research organizations from six EU Members States, three non-EU Member States and two collaborating partners.

    Loveness Dube comes from Chipinge, Zimbabwe and completed her high school education in Harare. In 2009 she obtained a Bachelor in Social Work at the University of Fort Hare in South Africa, and worked as a social worker at Johannesburg Child Welfare. She completed a Master in Public Health at the University of Pretoria in June 2013. From end 2013 to 2017 she enrolled in a PhD program at the Université catholique de Louvain (UCL) in Belgium and participated in the Diabetes Literacy study.