Title : Community-based diabetes care for older adults in rural Nigeria: Integrating screening, health education, and social support for sustainable aging
Abstract:
Objective: Rural Nigeria faces widened health inequities among older adults living with diabetes. This study integrates the Information–Motivation–Behavioral Skills (IMB) model through community-based screening, culturally tailored health education, and social support—an innovation in diabetes care delivery.
Methods: We recruited 150 older adults (≥ 60 years) in St. Louis Hospital Zonkwa from January to March 2024. Ethical permission and consent were obtained from the Ethics Committee panel of St. Louis Hospital Zonkwa, and all participants gave informed consent before taking part in the study. Quantitative data on diabetes knowledge, fatalistic attitudes, social support, and self-care practices were collected, along with Hemoglobin A1c (HbA1c), a long-term marker of average blood glucose from clinical records. Structural equation modeling (SEM) evaluated theoretical pathways.
Results: Diabetes knowledge had a positive effect on self-care (r = 0.25, p < 0.05), while fatalistic attitudes hindered care (r = –0.22, p < 0.05). Social support also improved self-care (r = 0.30, p < 0.01). Self-care behaviors significantly correlated with lower A1c (r = –0.22, p < 0.05). The SEM explained 31% of the variance in diabetes self-care behavior (R² = 0.31). The model is moderately fit (CFI=.85; RMSEA=.09), which indicates that, though the IMB model does capture some significant predictors, other structural variables may also be necessary. These are among issues such as lack of access to healthcare, cultural beliefs, and financial costs.
Conclusion: The study reveals serious gaps in diabetes knowledge, persistent fatalistic beliefs, and limited access to care, each posing a threat to sustainable aging. These findings suggest that behaviorally informed interventions grounded in education and social support hold promise for scalable implementation in similar low-resource, community settings. Future prospective studies are needed to confirm the identified pathways and examine the long-term impact on glycemic control, as well as aging-relevant outcomes.
Practice Implications: Aligning with IPHC themes, this community-driven, equity-focused model supports global health policy aiming at scalable NCD management solutions in low-resource settings.
Keywords: Diabetes care, community-based care, Older Adults, rural Nigeria, Health Education, Screening, Social Support, Sustainable Aging.
