Health

Researchers Design Community-led Behavioural Change Model to Control Rate of Type 2 Diabetes among Rural Population

Published

4 years ago

October 5, 2021

Mark Wamai

Dr. Juliet Kiguli (3rd Left), Bob Kirunda (4th Right) and Sr. Nabwire Mary (Right) with some of the research team and health practitioners who conducted research on social norms influencing type 2 diabetes risk behaviours

_{By Joseph Odoi}

Globally the proportion of undiagnosed diabetes is high, standing at 46.5%. In high-income regions like Europe, of all persons with Type 2 Diabetes Mellitus (T2DM), 39.3% are undiagnosed. Low-income countries in Africa have the highest prevalence of undiagnosed diabetes, estimated at 66.7%. In Uganda alone, a steady increase in the number of diabetes cases has been observed.

Despite the increasing burden of diabetes in the country, little is known about the socio-cultural norms influencing type 2 diabetes risky behaviors, especially in rural areas to inform action.

In the bid to contribute to data driven interventions, Makerere University researchers with funding from Government of Uganda and Makerere University Research and Innovations Fund (Mak-RIF) carried out a study to understand the patterns of socio-cultural norms in two high incidence districts namely, Busia and Bugiri, in Eastern Uganda.

As part of this study, researchers engaged various health stakeholders who shared their experiences about behaviors factors influencing type two diabetes.

It is upon that background that researchers co-designed a contextual strategy to ensure behavioral change to limit type two diabetes among the rural population under the project titled; “Socio-cultural norms influencing Type 2 Diabetes risks Behaviours – an exploratory to intervention co-design innovative study in two high incidence districts of eastern Uganda”. The strategy was developed by a team of researchers led by Dr. Juliet Kiguli, a Senior Lecturer in the Department of Community Health and Behavioural Sciences at the School of Public Health, Makerere University.

According to Dr. Kiguli, despite evidence confirming a high rate of T2D in Uganda, there is hardly any innovation that speaks to the deep rooted causes of Type 2 Diabetes hence the justification for their new model.

‘’There is enough evidence in Uganda at the national and local/community level confirming a high rate of T2DM, compared to the measures/innovations that try to address the disease. We can argue with confidence that most of the research around T2DM in Uganda and Africa has been largely academic and hasn’t been translated into action at a comparable pace of disease incidence and prevalence. Additionally, since the T2DM is largely a lifestyle disease that is influenced by external factors, exposure and social constructs, the solution to T2DM needs to be socially constructed, and currently, there is no innovation that speaks to the deep rooted causes of T2DM – this is the reason why we designed an evidence based innovation that is socially constructed to address diabetes with prevention in mind too‘’she explained of the model

The Assistant Commissioner Non Communicable Diseases (NCDs) at Ministry of Health, Dr. Gerald Mutungi who participated in the study’s innovation co-design had this to say;

“This study is unique, I have learnt many things which I had never looked at from a perspective of social norms and I am glad that we are already designing an innovation together with the community stakeholders and influencers to mitigate and reduce T2DM”.

He also tasked researchers to give answers on why people doing their daily activities and living a normal lifestyle still get diabetes.

Approaches behind the model

As part of the behavioral change strategy, the research team came up with the following approaches to their community-led behavior change model.

T2DM organized diffusion messaging and practices

This approach of the model will work through community-level social networks and will be used to conduct myths bursting sessions, building new positive social norms and spreading them using social networks related to the norm. This approach will be complemented by deliberation and reflection methodologies and the intent is to create shared commitments to change negative and/or maladaptive risky behaviors around T2DM.

Community-leader-initiated behavior modeling for T2DM

Because of power, control and therefore influence, this approach will target political leaders, religious leaders, cultural leaders, informal community leaders and all individuals with influence to model, demonstrate and promote the recommended behaviors and practices. This will be the first level of establishing reference groups and this approach will complement other approaches.

T2DM Non-conforming trendsetters and positive deviants.

In the co-design process, evidence shows the existence of trendsetters and positive deviants who are willing and able to be the first movers in initiating positive normative change around T2DM risky behaviors. Their nonconformity to the social norms around T2DM will contribute to the erosion of strong perceptions in favor of the negative gendered social norms that facilitate entrenchment of T2DM risky behaviors. This approach will be complemented by creation of new risky-behavior-specific reference groups that are able to enact alternative social sanctions against T2DM risky behaviors.

On timing of this model, Mr. Ramadhan Kirunda who was key in innovating the model noted that evidence from the social-norms study revealed a disconnect between the health system and the social system constructs at community and family level, yet T2DM risky behaviors are gendered and influenced by power, control and sanction around submission.

‘’Social norms are responsible for the harmful constructions of dominant masculinity engineered by power and control over women, hence the social-cultural acceptance of inferiority on the part of women. Therefore, even on matters of diet, women have to submit and follow what men prefer, and can become violent in asserting their dominance if women don’t comply. It is important to note that while gender-injustice related consequences affect mostly women, gendered social norms undermine the health and wellbeing of all people, regardless of age, sex, gender, or income setting. Therefore, our proposed model is informed by this reality, it is inclusive by design since it was co-designed together with all community stakeholders/duty bearers and targets risky behaviors that accelerate T2DM, but also other health outcomes.

KEY FINDINGS FROM THE SOCIAL NORMS STUDY

The main behavioral factors influencing type 2 diabetes were a) consuming processed and added sugar products, b) consuming high cholesterol fatty foods, c) excessive alcoholism, d) smoking (traditional and contemporary), e) mental/psychosocial stress and f) lack of exercise. The analysis shows that dietary factors contribute the greatest threat to the fight against type 2 diabetes in Busia and Bugiri according to the researchers.

In terms of social norm strength around dietary factors, the two strongest norms were “people who don’t prepare fried food are poor people”, “taking tea without adding sugar is mistreatment to your husband” and “Bwita/kalo is our staple food, we eat it daily”. Some of the less strong norms included; “eating greens is mistreatment to your man/husband”, “fat people especially men are respected in the community”, and “A true Samia meal must contain meat or fish daily” said one of the study participants

The strongest social norms around alcoholism.The strongest social norms around alcoholism were “alcohol takes away negative thoughts and stress”, “when you take alcohol with your friends, they can’t abandon you”, “Waragi reduces diabetes because it is sour”, “religion does not allow us to take alcohol” explained one of the key informants.

The social norms around smoking included; “if you want to feel good, you have to smoke”, “most old people and our grandparents lived long and were smokers” and “traditional religion demands and allows smoking of pipes, it’s part of our culture”. Affirmed another study participant

The main social norm around physical exercise was that “men are expected to rest/lie down and wait to be served by women”. They have to sit and wait for food’’ added a participant

On drivers that support norm entrenchment, the researchers outlined easy access to alcohol, gender based violence, cultural set up, poverty, wrong peers, poor parenting, one sided food systems as areas that need serious attention.

MORE ABOUT THE STUDY

The study used Social Norms Exploration Tools (SNET). It was conducted in Eastern region in the districts of Bugiri and Busia in December, 2020. This study covered a total of 4 health facility catchment areas: Bugiri Hospital, Nakoma H/C IV, Masafu Hospital and Lumino H/C III.

A number of data collection methods were used including Focus Group Discussions. Key Informant Interviews, In-depth Interviews, Observation and Photography.

This study builds on previous studies funded by Swedish Embassy and conducted in Iganga and Mayuge by the School of Public Health’s Prof. Guwatudde David, Dr. Barbara Kirunda, Dr. Elizabeth Ekirapa, Dr. Roy Mayega and Prof. Buyinza Mukadasi (Research and Graduate Training, Makerere University)

The research team consisted of the following researchers: Dr. Juliet Kiguli (Principal Investigator), Dr. Roy William Mayega, Dr. Francis Xavier Kasujja, Mr. Ramadhan Kirunda, Ms. Gloria Naggayi, Ms. Joyce Nabaliisa, Ms. Rita Kituyi, Sr. Nabwire Mary, and Sr. Nampewo Evarine Wabwire. The social norms study was made possible with funding by Mak-RIF (led by Prof. Bazeyo William) and Government of Uganda.

Related Topics:Bugiri Busia Diabetes lifestyle Mak-RIF MakSPH Model prevalence Research rural social study T2DM Type 2 Uganda

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Health

MakSPH, DJC Launch Short Course on Health Communication

Published

7 days ago

June 20, 2025

John Okeya

The heads of the Department of Journalism and Communication and the Department of Community Health and Behavioural Sciences (centre) with participants from the first cohort of the Health Communication short course at Makerere University. June 5, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa.

_{By Okeya John and Primrose Nabankema}

The intensive one-month course, running for the first time from June 5 to July 24, 2025, is jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC) at the School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa.

It seeks to equip healthcare providers at the community level, public health and environmental health practitioners, communication specialists, health educators, community development officers, social scientists, and policy makers, among others, with strategic communication skills to improve public health messaging, strengthen community engagement, and support evidence-based interventions, ultimately empowering participants to effectively engage communities and improve population health outcomes across Uganda and the region.

Launching the course, the heads of the Department of Journalism and Communication and the Department of Community Health and Behavioural Sciences noted that participants who complete the short course will gain practical tools to influence behaviour change, build trust, and deliver timely, accurate, and relevant health information to the communities they serve. The first cohort attracted more than 60 applicants, with 36 reporting for the opening in-person session on June 5, 2025, at MakSPH in Mulago. Between now and July, participants will undergo a hands-on, multidisciplinary learning experience within the Certificate in Health Communication and Community Engagement program, which combines theory and practice.

Among the participants in the first cohort of the certificate course, designed as a pilot for the anticipated Master of Health Promotion and Communication to be jointly offered by the two departments at Makerere University, is Ms. Maureen Kisaakye, a medical laboratory technologist specialising in microbiology and antimicrobial resistance (AMR), and currently pursuing a Master’s in Immunology and Clinical Microbiology at Makerere. She is driven by a passion to help reverse the rising tide of AMR, a growing global health threat where drugs that once worked are no longer effective. Kisaakye is particularly concerned about common infections, like urinary tract infections, becoming increasingly resistant and harder to treat.

“I enrolled in this course because I’m an advocate against antimicrobial resistance, and it came at a time when I needed to deepen my knowledge on how to implement our projects more effectively and engage with communities. The experience has broadened my understanding of AMR and its impact on society, and strengthened my passion for community-driven health initiatives and advocacy,” Kisaakye said, explaining why she enrolled for the short course.

Ms. Maureen Kisaakye (in white) during a youth-led community AMR and WASH awareness campaign in informal settlements in Kamwokya, Kampala, on 12th April, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa. — ***Ms. Maureen Kisaakye (in white) during a youth-led community AMR and WASH awareness campaign in informal settlements in Kamwokya, Kampala, on 12th April, 2025.***

Kisaakye’s work in antimicrobial resistance extends beyond the lab. Having earned her degree in medical laboratory science from Mbarara University of Science and Technology, she founded Impala Tech Research in 2024 to drive impact and save lives. She has led grassroots AMR campaigns that integrate antimicrobial stewardship with water, sanitation, and hygiene (WASH) education in underserved urban communities, including the informal settlements in Kampala. She also has since designed peer-led initiatives that empower university students as AMR Champions, building a network of informed youth advocates. Kisaakye believes the health communication course will sharpen her ability to design and deliver impactful, community-centred interventions in response to the growing threat of drug resistance.

“The department collaborates with many partners within and beyond the University, including the School of Public Health, where we are working to develop the subfield of health communication and promotion. Our goal is to train specialists in this area and build a community of practice, something we have each been doing in our own spaces. There’s a lot of work ahead, and COVID-19 showed us just how urgently we need a generation trained to do this kind of work, and to do it very well,” said Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, during the opening of the short course on June 5.

Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, underscored the partnership between DJC and MakSPH as a crucial step toward strengthening public health through strategic communication. June 5th, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa. — Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, underscored the partnership between DJC and MakSPH as a crucial step toward strengthening public health through strategic communication. June 5, 2025.

She assured participants they were in good hands and underscored the importance of the partnership between the Department of Journalism and Communication and the School of Public Health, describing it as a vital collaboration that brings together strategic communication and public health expertise. This dynamic, multidisciplinary approach, she noted, is essential to developing practical solutions that empower communities, strengthen health systems, and ultimately improve livelihoods.

The course offers a hands-on, multidisciplinary learning experience, with participants intended to explore key modules including Health Communication and Promotion, Risk Communication, Smart Advocacy, Community Mapping, Community Mobilisation and Empowerment, and Strategies for Community Engagement. The course combines theory with real-world application, and its assessment includes a field-based project and a final exam.

“You are our first cohort. We are seeing the fruits of our efforts in bringing this short course to life. It was born out of a joint initiative to develop a Master’s programme in Health Promotion and Communication,” said Dr. Christine Nalwadda, Head of the Department of Community Health and Behavioural Sciences. “We carried out extensive consultations with our different key stakeholders during the process and discovered a real need for such a course. It was the stakeholders who even named it; this course name didn’t come from us.”

For Kisaakye, by the end of the course in July, she hopes to have sharpened her skills in health promotion and strategic communication, particularly in crafting targeted messages that help individuals and communities effectively respond to threats such as antimicrobial resistance. She also aims to gain practical experience in designing, implementing, and evaluating community health initiatives that can strengthen her advocacy and drive lasting impact.

Dr. Marjorie Kyomuhendo, one of the course facilitators, engages Mr. Jackson Ssewanyana, a participant in the first cohort of the Certificate in Health Communication and Community Engagement, as Ms. Maureen Kisaakye listens in. June 5, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa. — Dr. Marjorie Kyomuhendo, one of the course facilitators, engages Mr. Jackson Ssewanyana, a participant in the first cohort of the Certificate in Health Communication and Community Engagement, as Ms. Maureen Kisaakye listens in. June 5, 2025.

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Health

Call for Abstracts: 2nd East African Symposium and Expo on Trauma, Injuries, and Emergency Care – 2025

Published

1 week ago

June 19, 2025

Mak Editor

Kickoff training for teams tasked with collecting data for the Uganda Population-Based HIV Impact Assessment (UPHIA) 2024-2025, held 19th May 2025, Makerere University School of Public Health (MakSPH) Auditorium, Main Campus, Kampala Uganda, East Africa.

The Makerere University School of Public Health (MakSPH) is excited to invite researchers, professionals, and students to be part of an inspiring and impactful event!

Venue: School of Public Health Auditorium, Makerere University Main Campus
Dates: August 7–8, 2025
Theme: “Understanding the burden and impact of injuries in East Africa to improve Emergency Care preparedness, mitigation, and response.”

Submit Your Abstracts Now!

Join the conversation that drives change in trauma and emergency care across East Africa. Share your research, innovations, and insights that can shape the future of healthcare response in our region.

Submission Deadline: July 10, 2025
Submit here: triadcommunications@musph.ac.ug
Register to Attend: https://aapug.org/east-african-symposium-and-expo-on-trauma-injury-disability-and-emergency-care-2025/

Together, let’s drive change and improve lives through research and collaboration. Don’t miss this opportunity to make a difference!

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Health

Scholarship Opportunity: Impact of Food Supplementation

Published

2 weeks ago

June 16, 2025

Mak Editor

Dr. Roselline Achola on Graduation day being welcomed by her teachers following her PhD award. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

MAKERERE UNIVERSITY CHILD HEALTH AND DEVELOPMENT CENTER

PhD SCHOLARSHIP FELLOWSHIP TRAINING ADVERTISEMENT

Impact of Food Supplementation on Health, Growth, and Development for Stunted
Children

We are seeking to appoint a full-time PhD Fellow to conduct a randomized controlled clinical trial (RCT) among 300 young children with stunting to assess the effect of Soy Lipid-based Nutrient Supplement with high versus low levels of antinutrients on growth and health of children on a DANIDA-supported project entitled “Climate-resilient soybean for improved growth and health of children in Uganda” (Healthy Soy). The PhD fellow will coordinate the RCT protocol development and its implementation, develop and nest his/her PhD protocol as part-of the RCT study. The PhD student will be hosted at the Child Health and Development Center School of Medicine College of Health Sciences, Makerere University. The PhD student will take part in literature review; designing, planning and conducting of studies; analysing results; writing reports and contributing to technical and policy briefs, journal articles and thesis; project management; organizing research seminars and stakeholder workshops; and guiding junior researchers and teaching. The PhD student will have access to online libraries, scientific databases and software for data analysis throughout their work. In addition, the student will be mentored by national and international researchers to develop scientific research and project management skills with three months stay in Denmark. By the end of the project, the selected candidate will have obtained significant competencies to explain the interactions between nutrition and health of children, growth and development. In addition, the student will gain skills in assessment of body composition, development and conduct of clinical trials design, scholarly writing and presentations, data analysis and interdisciplinary research.

Prospective candidates must:

Hold Masters in any of the following or equivalents: Human Nutrition, Dietetics, Public
Health Nutrition, Medicine in Paediatrics and Child Health, Public Health or
Epidemiology with undergraduate training in Medicine and Surgery (MBChB/MBBS/MD).
Having publication experience will be an added advantage.
Be highly motivated and interested in pursuing rigorous research
Be committed to a long-term research career in Human Nutrition and Health
Be of untainted integrity
Be able to use different software for data analysis and graphics.

Successful fellow will be expected to:

Conduct high quality research leading to publications in high-impact journals (must be
ready to work towards publishing a minimum of one quality paper per year).
Contribute to research capacity building including training of undergraduate and M.Sc.
students in the host department.
The project will avail financial support to the successful PhD Fellow for 4 years. Funds
will cover: PhD tuition for 4 years; monthly stipend; research supplies and reagents;
conference participation and other research-related costs.

Interested applicants should send an application letter, motivation statement, two
recommendation letters, CV and academic transcripts and certificates for all university
qualifications in an email titled “PhD Fellowship Application – Healthy Soy Project” to
chdc.desk@mak.ac.ug by 26^th June 20205.

Female candidates are strongly encouraged to apply. Only shortlisted applicants will be
contacted for interviews.

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