Tailoring a Peer-Delivered Psychological Intervention for Individuals with Type 2 Diabetes Mellitus in Nigeria

Background: Individuals with type 2 diabetes mellitus (T2DM) commonly experience mental health problems which makes it challenging for them to adhere to self-management behaviours and consequently affects glycaemic control. Addressing the mental health need of individuals with T2DM with poor glycaemic control is recognized as critical in diabetes care, but the dearth of mental health professionals in resource limited settings including Nigeria makes this difficult. Evidence from developed countries suggests that non-specialists (people without intensive professional training in the field of mental health) can be trained to deliver psychological interventions for people with T2DM including those with poor glycaemic control with beneficial health outcomes. However, the effectiveness of this approach has not been investigated. Thus, this PhD set off by evaluating the effectiveness of non-specialist delivered psychological interventions on glycaemic control and mental health problems for persons living with T2DM as well as uncovering the need for this intervention in Nigeria, with the overarching aim to tailor an appropriate intervention for the Nigerian setting. Methods: This PhD thesis was conducted in two phases; secondary and primary research, which were embedded within the first two stages of the ADAPT-ITT framework (Assessment and Decision). The assessment stage involved a systematic review and meta-analysis to examine the effectiveness of non-specialist delivered psychological interventions for improving glycaemic control and mental health problems in individuals with T2DM. In-depth qualitative studies were carried out with participants from secondary healthcare facilities to explore the experiences of healthcare professionals involved in the care of people with T2DM with poor glycaemic control and that of patients with T2DM with poor glycaemic control. Results: Findings from the systematic review and meta-analysis suggested that non-specialist delivered psychological interventions with longer sessions had the potential to improve glycaemic control and alleviate mental health problems in individuals with T2DM. Findings from qualitative interviews showed the need for psychologically informed intervention as well as maladaptive perceptions about T2DM, coping strategies and use of traditional medicine among individuals with T2DM and poor glycaemic control. In line with the ADAPT-ITT framework, interventions that were a good fit for the Nigerian setting were selected and modifications were proposed based on the findings from the systematic review, semi-structured interviews with healthcare professionals and patients. A draft of the proposed intervention which was termed “My Padi for Beta Health” is presented. Conclusions: The work reported in this thesis adds to the intervention literature and addresses gaps in knowledge in relation to the availability of a peer-delivered psychological intervention for individuals with T2DM with poor glycaemic control in the Nigerian setting using the ADAPT-ITT framework. Refinement and evaluation of the proposed intervention are essential to establish its feasibility, acceptability and effectiveness, with the need to involve key stakeholders such as patients, healthcare professionals, developers of original interventions and mental healthcare specialists in the ongoing adaption and evaluation process.