The Open Public Health Journal




ISSN: 1874-9445 ― Volume 12, 2019
RESEARCH ARTICLE

A Context-Specific Training Programme for Home Based Carers Who Care for People With Diabetes: A Necessity at Ga-Dikgale Village in South Africa



Mamare A. Bopape1, *, Tebogo. M. Mothiba1, Hilde Bastiaens2
1 Department of Nursing Science, School of Health Care Sciences, University of Limpopo, Limpopo, South Africa.
2 Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

Abstract

Introduction:

South Africa, like many countries, has been experiencing an increase in the prevalence of Type 2 Diabetes Mellitus (T2DM) and is amongst the top five countries with a high number of diabetes mellitus cases. Home Based Carers (HBCs) have been involved in the care of people with diabetes because of the need for efficient and cost-effective use of healthcare resources, especially in low-income countries. Previous research showed that HBCs are insufficiently trained in T2DM which leads to low-quality care but also disrespect by patients towards HBCs. The aim of this article was to develop a training program necessary for HBCs who care for People With Diabetes (PWD).

Methods:

Mixed method was used for the main study and both qualitative and quantitative data were collected to serve as a base for this phase. ADDIE model was used to guide the development of the training programme for HBCs.

Results and Discussion:

A context-specific training programme consisting of three modules was developed: (1) Basic knowledge and classification of diabetes mellitus, (2) prevention and control of diabetes and (3) management of diabetes and prevention of complications by HBCs. Development of the training programme was necessary because its availability and training of HBCs will increase disease-specific knowledge.

Conclusion:

This is the first training programme developed for HBCs in this region to address diabetes knowledge training gaps. The training programme might be of assistance to other researchers who may want to train HBCs in their regions.

Keywords: Context-specific, Training programme, Home Based Carers, People With Diabetes, Diabetes Mellitus, Type 2 Diabetes Mellitus.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 12
First Page: 269
Last Page: 275
Publisher Id: TOPHJ-12-269
DOI: 10.2174/1874944501912010269

Article History:

Received Date: 22/01/2019
Revision Received Date: 06/05/2019
Acceptance Date: 21/05/2019
Electronic publication date: 31/05/2019
Collection year: 2019

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© 2019 Bopape et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Nursing Science, University of Limpopo, Private Bag X1106 Sovenga 0727, South Africa;
Tel: 0152682387; Fax: 0152673080; E-mail: mamare.bopape@ul.ac.za






1. INTRODUCTION AND BACKGROUND

Type 2 Diabetes Mellitus (T2DM) is common amongst Non-Communicable Diseases (NCDs) globally [1World Health Organisation. Non-communicable Diseases Progress Monitor 2015 2015.]. The fast-growing number of T2DM globally led to the evolution of numerous and different delivery modes to prevent and manage the condition [2Hill J, Peer N, Oldenburg B, Kengne AP. Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review. PLoS One 2017; 12(12)e0189069
[http://dx.doi.org/10.1371/journal.pone.0189069] [PMID: 29216263]
]. Regardless of various and diverse delivery modes to prevent T2DM and T2DM-related complications, the disease continues to be the fourth leading cause of deaths globally [3Alaofè H, Asaolu I, Ehiri J, et al. Community health workers in diabetes prevention and management in developing countries. Ann Glob Health 2017; 83(3-4): 661-75.
[http://dx.doi.org/10.1016/j.aogh.2017.10.009] [PMID: 29221543]
] and brings a substantial economic loss to people, families and the health systems [4WHO. Global report on diabetes 2016.]. Home Based Carers (HBCs) provide hypertension and diabetic care to members of the affected communities [5Spencer MS, Rosland A-M, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health 2011; 101(12): 2253-60.
[http://dx.doi.org/10.2105/AJPH.2010.300106] [PMID: 21680932]
]. Shortage of health care workers resulting in ineffective management of diabetes led to the need of HBCs to bring diabetes prevention and management practices to their communities [3Alaofè H, Asaolu I, Ehiri J, et al. Community health workers in diabetes prevention and management in developing countries. Ann Glob Health 2017; 83(3-4): 661-75.
[http://dx.doi.org/10.1016/j.aogh.2017.10.009] [PMID: 29221543]
].

South Africa, like many countries, is experiencing an increase and it was said to be amongst the top five countries with a high number of diabetes mellitus cases. According to the Statistics of South Africa [6Statistics South Africa Report on mortality and causes of death 2016.www. statssa. gov. za/ publications/ P03093/P030932016.pdf] on mortality and causes of death, diabetes is the second most common cause of deaths in South Africa. HBCs, also known as Community Health Workers (CHWs) have been recognised as an important part of the healthcare team to care for NCDs at the community level. They have been involved in the care of diabetes mellitus because there was a need for efficient and cost-effective use of healthcare resources, especially in low-income countries. HBCs involvement in the care of diabetes people at the community level has been found to be a promising approach for improving diabetes health outcomes [7Shah M, Kaselitz E, Heisler M. The role of community health workers in diabetes: update on current literature. Curr Diab Rep 2013; 13(2): 163-71.
[http://dx.doi.org/10.1007/s11892-012-0359-3] [PMID: 23345198]
]. HBCs serve as a link between healthcare services and community members because they have unique knowledge, cultural competency and a close relationship with the community [7Shah M, Kaselitz E, Heisler M. The role of community health workers in diabetes: update on current literature. Curr Diab Rep 2013; 13(2): 163-71.
[http://dx.doi.org/10.1007/s11892-012-0359-3] [PMID: 23345198]
].

The HBCs in many parts of South Africa are employed by the NGOs which receive funds from the government and they are supervised by professional nurses and coordinators at the Primary Care Level to oversee their daily activities [8Tsolekile L P, Puoane T, Schneider H, Levitt N S, Steyn K. The roles of community health workers in the management of non-communicable diseases in an urban township Afr J Prm Health Care Fam Med 2014; 6(1) Art. 693, 8 pages
[http://dx.doi.org/10.4102/phcfm.v6i1.693]
]. The study conducted by Abrahams-Gessel, Denman and Montano [9Abrahams-Gessel S, Denman CA, Montano CM, et al. The training and fieldwork experiences of community health workers conducting population-based, noninvasive screening for CVD in LMIC. Glob Heart 2015; 10(1): 45-54.
[http://dx.doi.org/10.1016/j.gheart.2014.12.008] [PMID: 25754566]
], revealed that HBCs often have poor knowledge about NCDs including diabetes mellitus and their risk factors.

In South Africa, patients lack respect for HBCs because they are not trained [10Maimela E, Van Geertruyden JP, Alberts M, et al. The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: A qualitative study. BMC Health Serv Res 2015; 15: 143.
[http://dx.doi.org/10.1186/s12913-015-0812-5] [PMID: 25880727]
]. HBCs who care for people with diabetes mellitus need to be capacitated with a structured training and support programme [11Tsolekile LP, Schneider H, Puoane T. The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town. Curationis 2018; 41(1): e1-8.
[http://dx.doi.org/10.4102/curationis.v41i1.1815] [PMID: 29781697]
]. The utilisation of adequately trained HBCs with ongoing supervision and support to perform clearly defined tasks can be more beneficial for people with NCDs at community level2. HBCs without formal training can be trained effectively to screen, prevent and manage People With Diabetes (PWD) [12Gaziano TA, Abrahams-Gessel S, Denman CA, et al. An assessment of community health workers’ ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: An observational study. Lancet Glob Health 2015; 3(9): e556-63.
[http://dx.doi.org/10.1016/S2214-109X(15)00143-6] [PMID: 26187 361]
, 13Abdel-All M, Putica B, Praveen D, Abimbola S, Joshi R. Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review. BMJ Open 2017; 7(11)e015529
[http://dx.doi.org/10.1136/bmjopen-2016-015529] [PMID: 29101131]
].

The current article is part of the larger study which was aimed at developing, implementing and evaluating a training programme for HBCs who care for PWD at Ga-Dikgale village in Limpopo province of South Africa. A mixed method approach following convergent parallel design was used during the situational analysis in Phase 1 of the main study to explore and describe practices, knowledge and training needs of HBCs. The overall purpose of this article was to describe the development of a context-specific training programme for HBCs who care for PWD at Ga-Dikgale village in Limpopo province.

2. METHODOLOGY AND DESIGN

In the whole study, the ADDIE model was used to guide the development, implementation and evaluation of a context-specific training programme for HBCs [14Chen Y, Chen T, Tsai L. Development and evaluation of multimedia reciprocal representation instruction materials. Int J Phys Sci 2011; 6(6): 1439.
[http://dx.doi.org/10.5897/IJPS11.066]
]. ADDIE model is a systematic instructional design and abbreviation of the following logical steps: Analysis, Design, Development, Implementation and Evaluation [15Branch RM. Instructional Design: The ADDIE approach 2009.
[http://dx.doi.org/10.1007/978-0-387-09506-6_2]
]. These steps are sequential meaning the output of one step becomes the input for the next step [16Wetty G. The Design Phase of the ADDIE model. Journal of GXP Compliance 2007; 11(4): 40-8.]. Furthermore, Wetty [16Wetty G. The Design Phase of the ADDIE model. Journal of GXP Compliance 2007; 11(4): 40-8.] indicated that it is an iterative feedback model because the results of the last stage are returned to the point of origin for feedback, to close the loopholes and or to refine the learning product. ADDIE model was followed in this study to ensure that correct steps were followed to develop appropriate learning material in an optimal manner, to meet the needs of the HBCs [17Piskurich GM. Rapid Instructional Design: Learning ID Fast and Right 3rd ed. 2015.
[http://dx.doi.org/10.1002/9781119207528]
]. This article focusses on the first three steps: analysis, design and development described below and have been used for the development of the training programme as illustrated in Fig. (1). In the last phase of the larger study, the last two steps will be reported on at a later date.

2.1. Step 1. Analysis

The analysis is the first step of ADDIE's model which was used to identify training needs in order to develop the training programme for the HBCs and which formed the basis of all other steps [18Akkoyunlu B, Arkün S. A Study on the development process of a multimedia learning environment according to the ADDIE model and students' opinions of the multimedia learning environment Interactive Educational Multimedia 2008; 17: 1-19.]. Needs analysis of diabetes information and education was conducted in the first phase of the study employing a mixed method approach and the results were published else where. The population for this study was all HBCs who care for diabetes patients at Ga-Dikgale village. Fifteen HBCs who were purposively selected because they had diabetic patients under their care volunteered to be interviewed during data collection period to address experiences and learning needs of Home Based Carers (HBCs) who care for diabetic people at Ga-Dikgale village. The total population of 53 HBCs available during data collection and willing to participate, were included in the study and completed the questionnaires which addressed diabetes knowledge HBCs.

2.2. Step 2. Design

The design step is the blueprint of how the training programme was created [19Cheung L. Using the ADDIE Model of instruction to Teach Chest Radiograph Interpretation. J Biomed Educat 2016; Article ID 95025726 pages.
[http://dx.doi.org/10.1155/2016/9502572]
]. The purpose of the designing step is to define the anticipated performance and suitable evaluation methods [15Branch RM. Instructional Design: The ADDIE approach 2009.
[http://dx.doi.org/10.1007/978-0-387-09506-6_2]
]. In the design step, learning outcomes were identified and formulated with the idea that the success of this training implementation depends on clearly formulated learning outcomes, to meet the needs of HBCs. Based on the learning outcomes, the training content, teaching/learning methods, instructional strategies and assessment criteria were designed.

Fig.(1)
Summary of activities of the ADDIE model in the development of the training programme.


Two types of the learning outcomes namely; critical cross-field outcomes and specific learning outcomes were formulated in this study. Critical cross fields were adopted from the South African Qualifications Authority (SAQA) [20South African Qualifications Authority (SAQA) 2005.www. saqa. org. za/ docs/pol/ 2015/ National%20Policy%20for%20Assessment]. The research team used information gathered from the analysis step (situational analysis) to create a plan to bridge the learning gaps (training needs) identified and developed the specific learning outcomes. SAQA format, which was followed, encompasses the following elements: the name of the training programme, National Qualification Framework (NQF) level, Credits which reflect the average length of time the learner takes to complete learning of which 10 (ten) notional hours equal to 1 (one) credit, purpose of the training programme, duration of the programme, learning assumed to be in place, critical cross-field outcomes, specific outcomes and assessment criteria, Unit standard and programme assessment.

Table 1
Qualitative results.


2.3. Step 3. Development

According to the ADDIE model, the development step is where the researcher creates and assembles the content of the programme assets created in the design phase [21Niari M, Hartofylaka A M. Instructional Design of the WaW e-courses. J Open Distance Edu Educat Technol 2017; 13(2)
[http://dx.doi.org/10.12681/jode.15274]
]. The aim of this step was to create the learning content that incorporates all the learning needs of the HBCs, and also to develop learning materials with learning outcomes that are relevant, legible and reader-friendly for the level of the HBCs. In this step, the structure and content of the training programme including learning activities, instructional and assessment strategies are aligned with developed learning outcomes.

3. RESULTS

In the next paragraphs, this paper presents the steps followed during training programme development guided by the ADDIE model.

3.1. Step 1. Analysis

Based on the knowledge questionnaire used in the first phase, of the major study the following knowledge gaps in relation to care and management for PWD were identified: definition of condition, types of diabetes mellitus, age group mostly affected Type 2, ideal range for normal and abnormal blood glucose levels, signs and symptoms, diabetic diet, prevention and control and complications and management of diabetic complications [22Bopape M, Mothiba T, Mutambudzi M, Wens J, Bastiaens J. Baseline assessment of knowledge of home based carers for people with diabetes in a rural village in south africa: A quantitative study. TOPHJ 2002; 12: 199-205,.
[http://dx.doi.org/10.2174/1874944501912010199]
]. The results obtained from the qualitative part of the study indicated the HBCs' activities during the provision of care, challenges experienced and training needs, whereby they have suggested the training topics during interviews [23Bopape MA, Mothiba TM, Bastiaens H. What Are the Experiences and Training Needs of Home-Based Carers in Dealing With Diabetes in a Rural Village in South Africa? An Explorative Study. Global Journal of Health Science 2019; 11(3): 52-62.
[http://dx.doi.org/10.5539/gjhs.v11n3p52]
] (Table 1).

The gaps identified from the quantitative results were supported by the training topics suggested by the HBCs during the interview sessions conducted. The full situational analysis results for the current training programme of HBCs have been obtained and is/will be reported elsewhere.

3.2. Step 2. Design

The design of the training programme is presented in Table 2. The care and management of people with diabetes training programme were designed as a 16 hours workshop which was divided into two eight hours session per day. The training programme was at Level 4 of the National Qualification Framework (NQF) with 11/2 credits. The contact sessions were divided into two for two groups of HBCs for interactive facilitation with different facilitators who were a professional nurse (researcher), a dietician, pharmacist and the psychologist.

Table 2
The design of the training programme.


The venue for the workshop was away from their work environment because work-related interruptions were avoided. The pre-requisites for this course were basic life skills, basic communication skills and basic interpersonal relationship at the community level. The training also had a corequisite for training namely; a Home Based Carer, able to read, write and communicate and has been an HBC at Ga-Dikgale village taking care of Type 2 diabetes patients.

The researcher formulated clear and precise learning outcomes using Bloom's Taxonomy to classify the following levels of learning: remember, understand, apply, analyse, evaluate and create [24Krathwohl DR. A Revision of Bloom's Taxonomy: An Overview. Theory into Practice 2002; 41:4: 212-8.
[http://dx.doi.org/10.1207/s15430421tip4104-2]
], so that the learner has no doubt about what was expected (Table 2). Critical cross-field outcomes which express qualities that should be achieved in all qualifications and Specific Learning Outcomes to address the participants' needs and requirements were formulated [20South African Qualifications Authority (SAQA) 2005.www. saqa. org. za/ docs/pol/ 2015/ National%20Policy%20for%20Assessment].

Content is the focal point for engaging the HBCs during the process of knowledge construction. The researcher determined the content that was consistent with the learning outcomes. Based on the learning outcomes, the researcher designed a training content which consisted of three modules: (1) basic knowledge and classification of diabetes mellitus, (2) prevention and control of diabetes and (3) management of diabetes and prevention of complications by HBCs. The modules also have units which are presented in Table 3.

Table 3
Content of the modules in the programme.


3.3. Step 3. Development of the Training Programme

Learning materials that covered all the SLO were designed at this stage. During the design of the learning materials, the researcher considered the competency level of the HBCs. The training materials were drafted first and then submitted for evaluation for representativeness, appropriateness, completeness and importance to the research supervisors, psychologists, dieticians and pharmacists before a final version was concluded. The psychologists, dieticians and Pharmacists were included because they formed part of the implementation of this training programme.

3.4. Content Development

The researcher considered the following aspects during content development: the relevancy of the content included in the specific learning outcomes and objectives to achieve the SLO. The process of preparing the content was based on interviews conducted during data collection and reviewed literature related to diabetes mellitus and published books [25Hsu T, Lee-Hsieh J, Michael A, Turton MA, Cheng S. Using the ADDIE Model to Develop Online Continuing Education Courses on Caring for Nurses in Taiwan. The Journal of Continuing Education in Nursing 2019.
[http://dx.doi.org/10.3928/00220124-20140219-04]
]. The researcher developed the content that matches the learning outcomes identified in the design step. The content was divided into three modules in line with the SLO. The first module was for basic knowledge and classification related to diabetes which was divided into units. Each unit has different content and further divided into sub-units. Table 3 gives an overview of the different modules of the training program.

3.5. Instructional Strategies

Learner-centered and problem orientated strategies were the guiding framework for accomplishing the learning outcomes. The researcher selected the instructional strategies that accommodated individual learner's rates of learning and learning style based on reviewed literature. The instructional strategies selected were lecturer’s method, discussion, active learning, and cooperative learning/group discussions, role plays and case-based exercises [26Gleason BL, Peeters MJ, Resman-Targoff BH, et al. An active-learning strategies primer for achieving ability-based educational outcomes. Am J Pharm Educ 2011; 75(9): 186.
[http://dx.doi.org/10.5688/ajpe759186] [PMID: 22171114]
].

3.6. Assessment Criteria

The strategies for assessment were developed at this stage in order to measure success gained from the developed programme. Assessment would be undertaken continuously throughout the implementation of the training as it is interlinked with all the activities. The researchers would use formative assessment strategies such as open-ended questions, group discussions, and peer assessment to assess the understanding of the HBCs and achievement of the learning outcomes during the workshop. In this context, the researcher formulated assessment questions at the end of every activity to assess comprehension of the content in relation to the learning outcomes of the specific unit. The assessment criteria are presented in Table 4.

Table 4
Specific learning outcomes and assessment criteria.


3.7. Training Materials

The training materials developed included hard copies of training manuals printed for each HBC and the power point sides which covered all the SLO.

4. DISCUSSION

The study aimed at developing a training programme for HBCs who care for diabetes mellitus people at Ga-Dikgale village in the Limpopo Province of South Africa. It led to the design and development of a context-specific training programme for HBCs who care for diabetic people at Ga-Dikgale villages. This is the first training programme which was developed on the care of PWD in this context targeting the HBCs. The programme developed marks the beginning of the journey to strengthen the performance of HBCs in the provision of services to diabetes mellitus patients .

Instructional design system following the ADDIE model provided practical steps for organising a training development project. According to Branch [15Branch RM. Instructional Design: The ADDIE approach 2009.
[http://dx.doi.org/10.1007/978-0-387-09506-6_2]
], ADDIE's model describes and prescribes what needs to happen during the process. The analysis, design and development were the only three steps followed at this phase. In consistent with the literature reviewed, the model was helpful because it is process-based and follows a systemic problem-solving approach that provided well-defined basic and easy to follow steps [14Chen Y, Chen T, Tsai L. Development and evaluation of multimedia reciprocal representation instruction materials. Int J Phys Sci 2011; 6(6): 1439.
[http://dx.doi.org/10.5897/IJPS11.066]
, 27He Z, Marquard J, Henneman E. Model guided design and development process for an electronic health record training program. AMIA Annu Symp Proc 2017; 2016: 1814-21.
[PMID: 28269940]
-29Malan Z, Mash B, Everett-Murphy K. Development of a training programme for primary care providers to counsel patients with risky lifestyle behaviours in South Africa. Afr J Prim Health Care Fam Med 2015; 7(1)
[http://dx.doi.org/10.4102/phcfm.v7i1.819]
].

The situational analysis provided an opportunity to complete a thorough analysis of HBCs' training needs that guided the designing and the development of the training programme. Major knowledge gaps and training topics were suggested and served as a foundation for specifying the learning outcomes, content and activities, instructional strategies and assessment strategies. In support of this, other studies conducted in Western Nepal and South Africa, respectively, indicated that the knowledge gaps were identified through assessment in order to develop training [29Malan Z, Mash B, Everett-Murphy K. Development of a training programme for primary care providers to counsel patients with risky lifestyle behaviours in South Africa. Afr J Prim Health Care Fam Med 2015; 7(1)
[http://dx.doi.org/10.4102/phcfm.v7i1.819]
, 30Gyawali B, Mishra SR, Neupane D, Vaidya A, Sandbæk A, Kallestrup P. Diabetes management training for female community health volunteers in Western Nepal: An implementation experience. BMC Public Health 2018; 18(1): 641.
[http://dx.doi.org/10.1186/s12889-018-5562-y] [PMID: 29783961]
]. In congruence with other findings Tsolekile, Schneider and Puoane [11Tsolekile LP, Schneider H, Puoane T. The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town. Curationis 2018; 41(1): e1-8.
[http://dx.doi.org/10.4102/curationis.v41i1.1815] [PMID: 29781697]
] reported that HBCs basic knowledge about diabetes is poor and it needs to be improved for community-based diabetes management to be successful. The benefit of using this model is that it permitted the researcher to refer and revisit previous steps during the process.

The design of the training programme was based on SAQA guidelines [20South African Qualifications Authority (SAQA) 2005.www. saqa. org. za/ docs/pol/ 2015/ National%20Policy%20for%20Assessment], even though HBCs have no professional body that regulates their training. The HBCs have a job description that describes their activities for caring for people with chronic conditions that is context specific and is developed by NGOs managers. The designing of the training must be based on SAQA because it was established to create a single, integrated, national education and training framework for the whole nation, and to improve the quality of education and training in South Africa [31Bezuidenhout M, Human S, Lekhuleni M. The new nursing qualifications framework Trends in nursing 2013; 1(1)http//fundisa.journals.ac.za. http//dox.doi.org/10.14804/1-1]. The adaptation of the SAQA standards format for guiding the design of the training programme was helpful in the planning of it.

Development of the training programme was necessary because it's availability and training of HBCs will increase disease-specific knowledge and this was supported by other studies like diabetes training of community health workers serving native Hawaiians and Pacific people [32Look MA, Baumhofer NK, Ng-Osorio J, Furubayashi JK, Kimata C. Diabetes training of community health workers serving native Hawaiians and Pacific people. Diabetes Educ 2008; 34(5): 834-40.]. The utilisation of ADDIE's model of instructional design in the development of the training programme benefited both the quality of the training content, teaching strategies, and assessments methods. The training content developed was based on the topics suggested by the HBCs during the interviews as emerged form themes after data analysis and the activities of HBCs during provision of care to PWD, and this was supported by the literature [25Hsu T, Lee-Hsieh J, Michael A, Turton MA, Cheng S. Using the ADDIE Model to Develop Online Continuing Education Courses on Caring for Nurses in Taiwan. The Journal of Continuing Education in Nursing 2019.
[http://dx.doi.org/10.3928/00220124-20140219-04]
].

The next phase in our study is the implementation of the training programme and evaluation of the effectiveness of the training programme. The evaluation would make it possible to establish the impact of the training programme.

5. LIMITATIONS OF THE STUDY

The stakeholders NGOs managers for HBCs, diabetic people, nurses from the clinics and community members were not involved during the situational analysis to assess the task performance of the leaners, who accordingto the ADDIE model, should have been involved, which is a limitation of this study. However, the results obtained from the needs assessment revealed enough clarity on the performance gap and learning needs to base our decision for developing the training programme. Although HBCs' performance gap and learning needs were enough for a basic training programme, further exploration of the stakeholders' perspectives at a later stage is suggested for more advanced training opportunities.

CONCLUSION

This paper concentrated on the development of a context-specific training programme. The first three steps of the ADDIE model (analysis, design and development) used as a guide and the program was successfully developed for the HBCs who care for PWD. The training programme developed consisted of three modules targeting learning outcomes: (1) basic knowledge and classification related to diabetes mellitus, (2) prevention and control of diabetes and (3) management of diabetes and prevention of complications by HBCs which will be facilitated within two sessions lasting for 16 hours each. The training material and assessment criteria were also developed. This is the first training programme developed for the HBCs in this region to address diabetes knowledge training gaps. The training programme might be of assistance to other researchers who may want to train HBCs in their regions. The training programme will be implemented and evaluated in the next phase.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Ethical clearance for this study was obtained from the Turfloop Research Ethics Committee (TREC) at the University of Limpopo (TREC/76/2016: PG). Permission to conduct the study was obtained from the Limpopo province Department of Health and from HBCs organisations managers.

HUMAN AND ANIMAL RIGHTS

No animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

Informed consent was obtained from the participants prior to data collection.

AVAILABILITY OF DATA AND MATERIALS

The data sets used during this study are available on request for the readers from the corresponding authors.

FUNDING

This study was supported by the Flemish Interuniversity Council (VLIR UOS Limpopo project), Grant Number: ZIUS2018AP021.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] World Health Organisation. Non-communicable Diseases Progress Monitor 2015 2015.
[2] Hill J, Peer N, Oldenburg B, Kengne AP. Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review. PLoS One 2017; 12(12)e0189069
[http://dx.doi.org/10.1371/journal.pone.0189069] [PMID: 29216263]
[3] Alaofè H, Asaolu I, Ehiri J, et al. Community health workers in diabetes prevention and management in developing countries. Ann Glob Health 2017; 83(3-4): 661-75.
[http://dx.doi.org/10.1016/j.aogh.2017.10.009] [PMID: 29221543]
[4] WHO. Global report on diabetes 2016.
[5] Spencer MS, Rosland A-M, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health 2011; 101(12): 2253-60.
[http://dx.doi.org/10.2105/AJPH.2010.300106] [PMID: 21680932]
[6] Statistics South Africa Report on mortality and causes of death 2016.www. statssa. gov. za/ publications/ P03093/P030932016.pdf
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"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


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(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


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(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


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(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

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"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


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(Delft University of Technology, The Netherlands)

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(Sapienza - University of Rome, Italy)

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Philippe Hernigou
(Paris University, France)

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Peter Chiba
(University of Vienna, Austria)

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Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

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(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


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