Effect of a peer support group intervention on medication adherence, self- care practices, and diabetes knowledge among patients with diabetes in Northern Ethiopia: a randomized controlled trial.

Abstract

Diabetes mellitus is a chronic condition that requires consistent adherence to treatment, regular self-care, and adequate knowledge of the disease to prevent complications and improve quality of life. However, many patients struggle to maintain optimal adherence and integrate self-care into their daily routines. Nowadays, many diabetes self-management modalities have emerged as a promising approach to address these gaps. This randomized controlled study evaluated the effect of a structured peer support program on medication adherence, self-care practices, and diabetes-related knowledge among patients with diabetes who attended follow-up at a tertiary hospital. A randomized controlled trial was conducted on 97 (intervention group = 48, control group = 49) adults with diabetes who were attending follow-up at Ayder Comprehensive Specialized Hospital (ACSH). Participants were randomly assigned to either a peer-support intervention group or a control group and followed for six months. The intervention comprised three structured peer-led sessions that focused on self-care, medication adherence, and diabetes knowledge. Outcomes were measured at baseline and follow-up using the Morisky Medication Adherence Scale (MMAS-8), adopted Diabetes self-care Activities (SDSCA) scale, and diabetes knowledge test (DKT). Data analysis was performed using chi-square tests, paired-sample t-tests, and independent-sample t-tests to compare baseline characteristics and evaluate intervention effects. Difference-in-differences (DiD) analysis was used to compare the intervention and control groups across outcome variables. Compared with the control group, participants in the intervention group demonstrated significant improvements across all outcome measures. Medication adherence increased by a net difference-in-differences estimate of (DiD = + 1.5 points, p < 0.001) on the MMAS-8 scale. Self-care practices improved by (DiD = + 1.3 days per week of recommended behaviors, p < 0.001). Diabetes knowledge scores also showed substantial gains, among both the insulin users (DiD = + 4.9-point, p < 0.001) and non-insulin users (DiD = + 3.4-points, p < 0.001) of the intervention group compare to controls. Integrating structured peer-support interventions into routine diabetes care may provide a practical approach to improving patient outcomes while optimizing limited healthcare resources in low-resource settings. Future research should evaluate the sustainability, scalability, and cost-effectiveness of peer-support education model, together with their long-term impact on quality of life.