Evaluation of the Health Education Program for Diabetic Patients at UNRWA Clinics in the Northern West Bank

Discussion Committee: 
Dr. Samar Musmar / Supervisor
Dr. Zaher Nazzal / Co-Supervisor
Dr. Mutasem Hamdan / External Examiner
Dr. Abdel-Salam Khayyat / Internal Examiner
Dr. Samar Musmar / Supervisor
Dr. Zaher Nazzal / Co-Supervisor
Rana Dawod Abdallah Abu Samra
Background: Diabetes and associated complications constitute a major health problem in Palestine where their rates are highest among the refugees populationthat is extremely vulnerable. Patient education has been considered an important part of the clinical management of diabetes which has been shown to be effective in improving metabolic control and reducing complications.Therefore, UNRWA launched a six-month pilot campaign, entitled “Life is Sweeter with Less Sugar”, to improve self -diabetic care among Palestine refugees. Objective: This study aims to evaluate the effectiveness of the diabetes education programapplied at UNRWA clinics in the North West Bank in addition to assessing the reasons for non-attendance of the program and the difficulties during its implementation. Methodology: The study was both quantitative and qualitative in nature. Pre and post UNRWA surveys were used to assess biometric measurements, physical activity and dietary behaviors of the participants. An interviewer-administered KAP questionnaire was used to assess participants’ knowledge at the end of program. In addition, 120diabetic patients who didn’t participate in the program were selected and evaluated on the reasons for not attending the program. Qualitative data were collected from focus group discussions with participants and health care workers to assess their opinions about the program. Result: A significant improvement was revealed in participants’ knowledgeabout diabetes self-management behaviorswith lowering of their mean levels of weight, body mass index,waist circumference, and blood sugar, whereas no significant changes were observed in total cholesterol and blood pressure. Attitudes and practices toward eating behavior and physical activity in participants were improved significantly at the end of the program. The qualitative results also showed that almost all participants appeared to have been satisfied with this comprehensive program in which almost all their needs were met. This was not without challenges where the participants and HCWs reported lack of designated spaces for exercise and cooking sessions as the main challenge.The interviews with HCWs revealed that the lack of enough cadres, time andcommitment from other partners and volunteers were the main difficultites reported by almost all of them. Lack of advertising for the program was identified as the main reason for non-attendance of the program. Conclusion: This study demonstrates that the UNRWA campaign was effective inimproving knowledge and diabetes self-management behaviors of the participants and reinforces the need for implementing similar education programs as an essential part of diabetes management. Long-term follow-up sessions are recommended to enhance the effectiveness of the program
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