DESIGN, IMPLEMENTATION, AND EVALUATION OF AN INDIGENOUS KNOWLEDGE HEALER-DELIVERED SCREENING FOR DIABETES AND FOOT INFECTIONS IN RURAL SOUTH AFRICA kathryn_chu@yahoo.com

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DESIGN, IMPLEMENTATION, AND EVALUATION OF AN INDIGENOUS KNOWLEDGE HEALER-DELIVERED SCREENING FOR DIABETES AND FOOT INFECTIONS IN RURAL SOUTH AFRICA

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South Africa

Oral only

South Africa (SA) has the highest diabetes mellitus (DM) prevalence in Africa. Indigenous Knowledge Healers (IKH) may serve as intermediaries to fill this gap and improve DM and foot infection management. This study aimed to design, implement, and evaluate the implementation outcomes of a pilot DM detection intervention using IKHs in rural SA.

We conducted a mixed-methods study on IKH-led screening and referral of clients with suspected DM to formal healthcare in rural SA. DM education and training were followed by the intervention of IKHs screening and referring DM clients, and the implementation outcome evaluations. Outcomes were assessed using qualitative and quantitative data.

199 screenings were conducted and 66 referrals made. Thirty-six IKHs were trained but only 1/3 actively adopted the intervention largely due to difficulties integrating screening into routine consultations and identifying eligible clients. To address workflow issues, some IKHs introduced student healers to assist with screening activities. Acceptability was limited by mistrust of community members being referred to the formal health sector. This was mitigated through community sensitisation and stakeholder engagement with clinics and community leaders. Fidelity was initially limited by literacy-related challenges in completing screening tools and documentation, but regular refresher training and supervision improved tool use.

Community based screening by IKH of DM is a strategy to reach clients who do not typically use formal health care. Sustainability will be conditional on collaboration with clinics, ongoing supervision, and access to supplies.