About us
History
The idea of ‘Living GREAT with diabetes’ originated in 2008 when Prof Bob Mash and colleagues ran an appreciative inquiry with public sector primary care providers in Cape Town, who were responsible for chronic care. Although the inquiry focused on how to improve the annual review of the person with diabetes, the teams also recommended that we do something about the education or empowerment of patients. They specifically suggested a group approach due to the large numbers of people. They also suggested that the groups be facilitated by health promotion officers and consist of four sessions. The four sessions should focus on understanding diabetes, lifestyle modification, adherence to medication and avoiding complications.
We took these suggestions seriously and designed such an approach to group empowerment. We worked with Prof Steve Rollnick to embed the principles of motivational interviewing into the design. We also looked at a variety of approaches to group education for diabetes internationally. We also noted that the Cochrane Collaboration found good evidence for the effectiveness of group education for diabetes in a systematic review. We piloted the final design with patients at Groote Schuur Hospital in Cape Town. Prof Dinky Levitt from the Chronic Disease Initiative for Africa helped with this.
We then conducted a pragmatic clustered randomised controlled trial in Cape Town to evaluate the effectiveness of GREAT for diabetes. This clinical trial demonstrated that the intervention was feasible and cost-effective in our context.
Following this, we realised that further work was needed to actually implement GREAT in South Africa. We were lucky enough to obtain a grant from the World Diabetes Foundation to scale-out GREAT from the Western Cape to the other provinces. At the same time, the local South African Medical Research Council as part of the Global Alliance for Chronic Diseases funded an evaluation of this implementation.
Implementation of GREAT for diabetes has been strongly supported by the National Department of Health. They saw the potential of GREAT to contribute to the goals of the National Strategic Plan for the prevention and control of non-communicable diseases. Particularly the goal that 50% of people receiving an intervention for diabetes should be controlled.
We are still busy with trying to scale-up GREAT for diabetes in the provinces where it was introduced – Northern Cape, North West, Gauteng, KwaZulu-Natal and of course Western Cape. As you can see not all the provinces took up the opportunity. This scale-out also coincided with the COVID-19 pandemic, which hampered the initiative.
The Western Cape, particularly the Metro Health Services in Cape Town, are now independently scaling-up GREAT for diabetes. We hope that the other provinces will follow suit in the near future. So far, this journey has taken 15 years, but we are committed to see it through.
