Increasing Physical Activity in Omani Adult Patients with Type 2 Diabetes Attending Primary Health Care Facilities, MUSCAT
The prevalence of diabetes is increasing globally including in countries of the Gulf Cooperation Council namely Oman. Physical activity has been recognized as a “cornerstone” in the management of diabetes, yet many individuals with diabetes fail to reach the recommended levels of at least 150 min/week of moderate to vigorous physical activity. The aims of this PhD thesis were to explore current levels of physical activity in this population, investigate barriers to activity and perceptions about a culturally effective, practical and acceptable approaches for activity promotion within local diabetes primary care in Oman. Using these findings, a physical activity intervention design (the “MOVEdiabetes” study) was then developed, implemented and evaluated. Formative work reported low levels of physical activity and prolonged sitting time in adults with type 2 diabetes. The odds of meeting PA recommendations were significantly greater in males, individuals ≤57 years, individuals reporting active stages of PA and those with no reported barriers to PA. ‘Lack of willpower’ (in both males and females), ‘Lack of resources’ and ‘Lack of social support’ (more in females) were the most frequently reported barriers. When participants and health care professionals were asked about acceptable intervention approaches in diabetes primary care, activity consultations were commonly recommended. The perceived actions required to achieve improved activity levels were to modify the current physical structure of the primary health care and provide in-service physical activity training for all health care professions. A multi-component physical activity “MOVEdiabetes” intervention design was developed for use in a cluster randomised trial. The study was undertaken over a one year period in eight health centres in Muscat. Participants in the intervention group received face to face personalised physical activity consultations on three occasions (0, 4 and 8 weeks), pedometers and monthly WhatsApp messages. The intervention included self-monitoring and feedback on step counts which was provided within physical activity consultations and discussed through WhatsApp communications whereas the comparison group received usual care. These visits also allowed for data collection by clinic staff for research purposes in all health centres at baseline, 3 and 12 months. Overall, out of 232 consented participants (122 in the intervention group vs 110 in the comparison group), 174 (75%) completed the final 12 month measurements (82 in the intervention group vs 92 in the comparison group). Results showed significant differences in change in physical activity levels at 12 months from baseline in favour of the intervention group [+447.4 (95%CI 150.7 to 744.1) (MET.min/week)]. Additionally, changes in (secondary outcomes) sitting time (-1.5, 95%CI -2.4 to -0.7 hours/day), step counts (+757, 95%CI 18.4 to 1531 steps/day), blood pressure (-1.8, 95%CI -3.5 to -0.1 and -1.6, 95%CI -2.6 to -0.7 in systolic and diastolic blood pressure mmHg, respectively), and triglycerides (-0.3, 95%CI -0.5 to -0.08 mmol/L) were all significantly improved in favour of the intervention group. No significant between group differences were observed for changes in the other anthropometric or metabolic outcome measures. Moreover, participants in the intervention group had significantly greater improvements in perceived general health, mental health, pain and quality of life compared to the comparison group. Using bespoke exit surveys and observation check lists, perceptions from the participants in the intervention group and project officers revealed that the “MOVEdiabetes” intervention was rated as satisfactory, acceptable, appropriate and was delivered with high fidelity. The “MOVEdiabetes” programme provided culturally specific intervention level evidence which (when combined with existing evidence) has the potential to influence relevant stake holders, to assist in the development and modification of national physical activity policies and the conduct of programmatic physical activity promotional initiatives. However, future research both locally and regionally, could usefully examine overall physical activity behaviour including the challenges of sedentary lifestyles, and acceptable tools for objective measurement of physical behaviours.
Physical activity, Type 2 diabetes, Intervention, primary health care, Oman
Networked Digital Library of Theses and Dissertations