Evaluation of the Microclinic Social Network Model for Palestine Refugees with Diabetes at UNRWA Health Centers

Abstract

Background: UNRWA provides primary healthcare for around 5.9 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. In 2015, UNRWA started, in cooperation with Microclinic International (MCI), to implement an innovative diabetes program, aiming at improving awareness about diabetes care among PRs with Diabetes Mellitus (DM). This program takes advantage of a unique model of “microclinic” MCI social network program, a novel social network based on diabetes education intervention. Methods: A quasi-experimental study was conducted to evaluate the impact of the UNRWA-MCI program in 115 UNRWA’s HCs in Jordan, Lebanon, West Bank and Gaza. 1000 participants were randomly selected from around 60,000 participants in the program. After training 996 nurses on UNRWA-MCI diabetes care modules, groups of 10 - 15 participants with their social networks (around 20 participants in each group) attended eight weekly sessions, during which the program was introduced. Anthropometric and blood pressure (BP) measurements were collected on weekly basis, while glycated hemoglobin (HbA1c) was tested before involvement in the program and after completion of sessions with a three month period between both measurements. SPSS Version 22 was used for data analysis. The study protocol was reviewed and cleared by UNRWA, Health Department ethical committee. Results: Out of 1000 patients randomly selected for the evaluation of the impact of the program, 969 (81.9% females, 18.1% males) have completed the study. The average weight loss was 2.0 ± 4.6 Kg and significant improvements were seen in waist circumference (WC), HbA1c and BP (p ≤ 0.001 for all). Overall drop in HbA1c was 0.6 ± 1.2 with 8.5% increase in patients with HbA1c < 7.0 and 9.8% decrease in those with HbA1c ≥ 7.0. About 10.0% of patients with abnormal BP (higher than 140/90 mg/dl based on UNRWA’s criteria for BP of diabetics) had shifted to normal BP. Conclusions and Recommendations: UNRWA-MCI program improved anthropometric measurements, HbA1c and BP in diabetic PRs. It improved diabetes care management for PRs, and led to the involvement of their social networks to support their behavior change for a healthy lifestyle.