President supports diabetes peer education in Turkey
With a hastily growing diabetes population in Turkey, the public health authorities have realised that action needs to be taken. The around 1,200 diabetes health specialists in the country cannot cover the 7 million people currently living with diabetes in the country.
One way of addressing the gap between diabetes patients and available health care personnel is peer education which is based on the belief that social behaviour is contagious. The World Diabetes Foundation (WDF) supports the Turkish Diabetes Foundation in a four-year peer education project which aims at mobilising and changing lifestyle among people living with diabetes or at risk of developing diabetes.
Peer education works
Peer education has proven very successful as a method to carry out health interventions in relation to chronic diseases. The reasons are manifold: First of all, peer education sessions are carried out by persons with whom the patients identify; secondly, the peer education sessions build on interaction between the peers which puts a mild social pressure on the participants because they are responsible vis-à-vis their peers; thirdly, the peer education sessions are carried out in a local dialect as opposed to medical terms which can create a distance to the participants’ everyday life.
In order to ensure this sense of familiarity it is crucial that peer educators come from the same regions as the patients because they have the necessary understanding of the local culture – also with regards to diet and exercising habits. The education set-up and material is the same in all regions of Turkey, but the local peer educators attempt to adapt the sessions to the local needs and cultural habits. So far, 33 peer educators have been trained in all regions of Turkey and have reached almost 24,000 patients.
“I feel like a new person”
In line with the principle of contagious health the peer education sessions do not only affect the patients; many of the participants highlighted that their increased knowledge levels and changed behaviour also had a positive spill-over effect on their families and friends.
Ms Dudu Sariyildirim is a retired air hostess who lives in Antalya. “I was diagnosed with hypertension several years ago but only recently acknowledged that I had diabetes too. My family doctor had diagnosed me more than a year ago, but I ignored it. Initially, I refused to take diabetes medication, but four months ago I felt more ill than usual, so I gave in,” she says. Since acknowledging her diabetes, [name] has made several lifestyle changes, including quitting smoking and starting to exercise on a daily basis. “The learnings from these sessions have made me feel like an entirely new person; I have lost a lot of weight and been able to reduce the medicine doses for hypertension.”
Government commitment to the project
According to project responsible for the Turkish Diabetes Foundation, Ms Raziye Gedikli, “one key factor in the success of the project is a strong commitment from the highest political level. When the project was launched, the President of Turkey contacted the governors of all provinces in the country in order for them to give support to the project. This has had a tremendously positive effect in terms of reaching patients and in creating a particularly high demand in rural areas,” she says.
The project which now extends nationally also enjoys the support of family physicians. At the Antalya Kepez Primary Health Clinic five family physicians are responsible for seeing some 50 patients per day. According to the physicians diabetes is ranked as the number four most frequent disease they deal with. They welcome the educational sessions, as they themselves are not able to allocate time to educate patients. “We see that some of the educated patients have started to take their diabetes more seriously and they now demand more information and support, rather than just getting a renewal of prescriptions. The peer education has a remarkable effect on the patients in terms of diet, exercise and adherence to treatment,” says one of the physicians, Dr Ertan Sahbaz.
Impact data needed
WDF Programme Coordinator, Mr Jakob Sloth Yigen Madsen recently visited project sites in Turkey and resonates the physician’s observation: “It was my clear impression that the educational sessions have already had a tremendous impact in the lives of those who attended. However, it is too early to draw any conclusions on the long-term effects as we will only know this over time. Furthermore, an impact assessment including quantitative data on HbA1C, BMI levels and adherence to medicine is needed to validate the impressions we got during our visit,” he says.
The project in brief
This project targets Turkey’s rural population with diabetes education in order to increase the awareness and knowledge of diabetes in areas with limited outreach activities.
The long-term objective is to create a nationwide diabetes education programme where peer advisers will disseminate awareness about diabetes in rural areas of Turkey.
The four-year project aims at educating 28 peer educators and reaching more than 16,000 patients in ten cities.
The Turkish Diabetes Foundation is implementing the project in collaboration with the Living With Diabetes Association, the Diabetes Dieticians Association and the National Nutrition Platform Association.
The project consists of three components:
1. Training of peer advisors
2. Education of patients
3. Organisation of support groups