Background This study is a qualitative assessment of a group diabetic education programme using motivational interviewing (MI) in underserved communities in South Africa. The programme was delivered by health promotion officers (HPOs) who are mid-level workers trained to deliver health education messages. The aim of the study was to explore the experience of the HPOs in the training course and in facilitating the group education sessions, and from an understanding of their perspective to contribute towards an in-depth evaluation of the educational programme. Methods The study made use of three focus group interviews with 14 health promoters who delivered the educational programme in 17 health centres in the Cape Town area. Interviews were recorded and transcribed verbatim. The data was analysed using the Framework method. Results Training was perceived as successful and the use of small group education as the main teaching method mirrored the challenges involved in group diabetes education. HPOs felt confident in their ability to deliver the group education after training. HPOs reported a significant shift in communication style and skills, but felt the new approach was feasible and better than usual. Resource materials were found to be relevant, understandable and useful. HPOs felt that the number of sessions and topics should be increased and that family members should also attend. HPOs struggled with poor patient attendance and a lack of suitable space at the facilities. HPOs reported that patients who attended demonstrated improved self-efficacy and self-care. Conclusion This qualitative assessment of HPOs perspective on a group diabetes education programme using MI showed that HPOs can deliver such a programme with the necessary confidence after adequate training. The HPO’s perspective needs to be triangulated with other research projects focused on the patient outcomes and perspectives and evaluation of the HPO’s fidelity and competency. This study however supports wider implementation of the educational programme.

Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.