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

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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
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.

  1. 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.

  1. 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.

  1. 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.

Mark Wamai

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Makerere Medical Journal: 52nd Edition

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23 hours ago

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June 25, 2026

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Cover page of the 52nd Edition of the Makerere Medical Journal. College of Health Sciences (CHS), Kampala Uganda, East Africa.


It is with great esteem that I welcome you to the 52nd edition of the Makerere Medical Journal (MMJ). This edition of the Makerere Medical Journal (MMJ) comes at a pivotal moment in our country’s history, a time marked by change and a growing determination for voices to be seen and heard. Various platforms have given people the opportunity to do just that and the MMJ is one of these platforms because, here, we believe there is no greater joy than visibility and expression.

Writing is one of the purest forms of self-expression, and research represents its highest academic form: writing grounded in facts and figures. Research is the very backbone that shapes the future of humanity. The hallmark of any society progressing In an evolutionary direction is RESEARCH. It, therefore, felt essential to include the work of so many bold, young writers and researchers whose work will shape the landscape of science for generations to come.

We invite you to embark on this journey of inquiry and to open your mind to the powerful ideas captured within these pages. “Research is always the best the part of writing.” What we especially love about this is the fact that our writers take their time to do their research before making submissions which made our work particularly easy. We were impressed with the quality of the submissions in spite of the rigorous academic schedules. We hope their brilliant writing speaks volume to you like it did to us. This edition features articles that explore emerging innovations and evolving ideas in medicine, including cancer research, gene editing, and other compelling areas of study we hope you will find equally thought-provoking. Makerere University College of Health Sciences (MakCHS), continues to be a hub of research prowess and excellence. The number of undergraduate students producing high-quality research continues to grow, and we are immensely proud to showcase their work in our journal.

Additionally, we believe it is of the utmost importance to get inspiration and guidance from those who came before us. On that note, we have included an interview from Dr. Sabrina Kitaka and Prof. David Meya, who both continue to shape and nurture the next generation of clinicians. We have also included two study abroad pieces that highlight the journey of two of our medical students through Sweden and Italy. We believe their experiences will inspire and motivate those coming after them. MakCHS is home to vibrant clubs whose activities have shaped the landscape of the student experience, which we are proud to have featured.

This edition is especially meaningful as it represents the continuation and completion of the outstanding work of the 2024–2025 editorial team. We extend our heartfelt gratitude to them under the leadership of Mr. Karlos Samuel, as well as, to our patron, Dr. Sabrina Kitaka, for her unwavering guidance and support. And finally, our deepest thanks go to you, our dearest readers, without whom this journal would not exist. We hope you find the inspiration you seek within these pages.

APILI LORRAINE,
MBChB V
Email: roritech[at]gmail.com

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Makerere Researchers Find Psychological Therapy Effective in Improving Diabetes Care in Uganda

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3 days ago

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June 23, 2026

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Study participants join Principal Investigator Professor Peter Baguma, members of the research team and officials from the Ministry of Health's Department of Mental Health and Control of Substance Abuse for a group photo after the dissemination workshop on 16th June 2026. Physiology Lecture Theatre at the College of Health Sciences, Mulago Hospital Complex, Makerere University, Kampala Uganda, East Africa.

By Nelson Bahati

Researchers from Makerere University‘s School of Psychology have found that psychotherapy intervention can improve the well-being of adults living with Type II diabetes mellitus, opening the door for integrating psychosocial support into diabetes care in Uganda.

The findings were disseminated on 16 June 2026 during a research dissemination workshop held at the Physiology Lecture Theatre at the College of Health Sciences, Mulago Hospital.

Led by Professor Peter Baguma, the study titled “The Effectiveness of Cognitive Behavioural Therapy for Diabetes Distress, Depression, Health Anxiety, Quality of Life and Treatment Adherence among Adult Patients with Type II Diabetes Mellitus” investigated whether Cognitive Behavioural Therapy (CBT), a psychological treatment that has proven effective in Western countries, could also work in the Ugandan context.

Presenting the findings, Professor Baguma said the study was motivated by the growing burden of diabetes and the psychological challenges that often accompany the disease but are rarely addressed in routine healthcare.

“Diabetes affects many people in Uganda and across the world. It kills, and those who live with it face many challenges. While psychological interventions have been developed and applied in the Western world, we did not know whether these approaches could work in Uganda. That is why we decided to undertake this study,” he said.

He explained that Cognitive Behavioural Therapy focuses on changing negative thoughts and behaviours that affect people’s wellbeing and ability to manage chronic illnesses.

The researchers sought to determine whether CBT could reduce psychological distress among diabetes patients and improve treatment outcomes.

The controlled study involved 200 adult participants with Type II diabetes mellitus. One hundred participants received the CBT intervention while another 100 formed the control group. Participants in the intervention arm attended eight counselling sessions over four months, with each session lasting between one and one-and-a-half hours.

The therapy covered several modules, including psychoeducation on diabetes, cognitive restructuring, medication adherence, problem-solving, coping strategies, physical exercise, relaxation techniques and strategies for maintaining treatment.

According to Professor Baguma, the findings showed that psychotherapy significantly improved participants’ wellbeing.

Professor Baguma Peter, the Principal Investigator presenting the study methodology and research design during the dissemination of findings. Physiology Lecture Theatre at the College of Health Sciences, Mulago Hospital Complex, Makerere University, Kampala Uganda, East Africa.
Professor Baguma Peter, the Principal Investigator presenting the study methodology and research design during the dissemination of findings.

“The group that received the intervention experienced reduced stress levels and lower blood sugar levels compared to those who did not receive the therapy. We conclude that CBT is effective and should be adopted as part of diabetes care,” he said.

The study also yielded another important discovery.

“We have discovered that CBT as practised in the Western world is somewhat narrow. Their manual contains only eight elements. In Africa, we found that three additional components are necessary: effective communication between patients and health workers, goal setting, and instilling hope among patients. We call this African CBT,” Professor Baguma explained.

He added that the findings had also revealed the need to incorporate psychosocial care into the management of chronic illnesses and to train healthcare workers to address the psychological dimensions of disease.

Professor Andrew Marcel Otim, one of the co-investigators and founder of the Uganda Diabetes Association, said the study had brought to the fore an aspect of diabetes care that has long been neglected.

“There have been many efforts to address the physiological effects of diabetes, but we have largely ignored the psychological part of the disease. Yet the psychological aspect is huge,” he said.

He added that, diabetes management should go beyond medication but rather intergrate other components of care.

“Education, nutrition, exercise and self-monitoring are extremely important. Even simply knowing what to do is a very powerful intervention. Psychological distress and depression can increase blood sugar levels, so we need to help patients remain calm and hopeful,” he said.

Drawing from his experience as a clinician and educator, Professor Otim encouraged people living with diabetes to embrace physical activity.

“I tell my students and my patients to put on some music, dance, sweat and enjoy themselves. Nutrition, education and exercise remain central to managing diabetes.”

Dr. Wilber Karugahe, a counselling psychologist at Makerere University‘s School of Psychology and one of the co-investigators, said the findings demonstrate the need to integrate psychological care into the management of chronic diseases.

“A lot of studies focus on physical illness and not the psychological conditions that accompany these illnesses. This study confirms that diabetes has a significant psychological aspect and that patients need psychological interventions as part of their care,” he said.

Explaining the essence of Cognitive Behavioural Therapy, Dr. Karugahe noted that the approach helps people restructure their thoughts and behaviours.

“Imagine putting a sticker on your fridge that reminds you that some foods are not good for you and that healthier options are better. That is CBT. It helps people change the way they think and behave, and it can be used to address many behavioural challenges.”

The dissemination workshop was also attended by officials from the Ministry of Health, including Mrs. Christine Ninsiima Ahimbisibwe, Senior Programme Officer for Mental Health and Substance Abuse Control, and Mrs. Patience Butesi from the Department of Mental Health and Drug and Substance Abuse.

Mrs. Ahimbisibwe welcomed the findings and emphasised the need to integrate the study’s recommendations into Uganda’s clinical guidelines to enable healthcare workers to provide psychosocial support to patients living with chronic illnesses such as diabetes.

The human impact of the intervention was perhaps best illustrated by testimonies from participants who underwent the psychosocial training.

Tebugulwa Josephine, a retired teacher and employee at Mulago National Referral Hospital, said the intervention restored hope in her life.

A study participant displays several diabetes medications as she narrates how the psychosocial intervention improved her ability to manage the condition. Physiology Lecture Theatre at the College of Health Sciences, Mulago Hospital Complex, Makerere University, Kampala Uganda, East Africa.
A study participant displays several diabetes medications as she narrates how the psychosocial intervention improved her ability to manage the condition.

“When we first joined the programme, we thought we were moving dead people. But now we have hope. I have hope of reaching 90 years. We were taught how to exercise and take care of ourselves. Even our families no longer treat us as sick people because we can now walk and participate in daily activities.”

Another participant, Bunje Joice, described the intervention as life-changing.

“People had already given up on me and were waiting for me to die. I could hardly walk, but now I can walk long distances and my diabetes levels have improved. Physical exercise has become my first medicine.”

Kyomuhendo Kate said the programme helped her manage stress and improve her health.

“I was so stressed and my legs were swelling, but after attending the treatment sessions, I am now much better.”

Sebuliba Bernard said the training transformed how he manages his condition.

“They taught us how to exercise, how to live and how to eat. If we follow what we were taught, we can change our lives.”

Based on the findings, the researchers recommended scaling up the intervention to district, regional and national referral hospitals, integrating psychosocial interventions into the training of health workers, and undertaking policy reforms to strengthen mental health support for people living with chronic illnesses.

The study was funded by the Makerere University Research and Innovations Fund (Mak-RIF) and brought together researchers from psychology and medicine, including co-investigators: Dr. Fredrick Nakwagala, Dr. Wilber Karugahe and Dr. Anne Ampaire.

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Call for Abstracts: USHS 25th Annual Scientific Conference 2026

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June 19, 2026

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Call for Abstracts: Uganda Society for Health Scientists (USHS) 25th Annual Scientific Conference 2026. Organised by Makerere University, Kampala Uganda, East Africa.

The Uganda Society for Health Scientists (USHS) invites researchers, academics, health professionals, students, policymakers, and development partners to submit abstracts for presentation at the 25th Annual Scientific Conference of the Uganda Society for Health Scientists (USHS), scheduled to take place from 6th–7th August 2026.

Conference Theme

“Human-Centered Health Systems in Uganda: Leveraging Finance, Innovation, and Digital Technologies for Lasting Impact.”

Conference Sub-Themes

Abstracts are invited under, but not limited to, the following areas:

  1. Malaria
  2. Tuberculosis
  3. HIV
  4. Public Health and Policy
  5. Data Science and Health Informatics
  6. Mental Health and Well-being
  7. Health Education and Capacity Building
  8. Non-Communicable Diseases
  9. Neglected Tropical Diseases
  10. Emerging and Re-emerging Epidemics
  11. Surgical Interventions
  12. Biosafety and Biosecurity
  13. Ethics
  14. Laboratory Medicine
  15. Vaccines
  16. Health Financing

Abstract Submission Guidelines

Option A (Research Abstracts)

  • Background
  • Methods
  • Results
  • Conclusions

Option B (Programmatic/Implementation Abstracts)

  • Background/Context
  • Program Description
  • Lessons Learned
  • Recommendations

General Requirements

  • Abstracts must be submitted in English and in Microsoft Word format.
  • The abstract should not exceed 300 words.
  • Tables and graphs may be included where applicable.
  • Previously presented work at national or international meetings is eligible for submission.

Important Date

Abstract Submission Deadline: 23rd June 2026

Submission

Please submit your abstracts via email to:
ushsecretariat@gmail.com
ushsugsociety@gmail.com

For further inquiries, contact the USHS Secretariat:

USHS Office, Makerere University College of Health Sciences
Department of Anatomy, 2nd Floor, Room C14
Tel: +256 414 531820
Mobile: +256 772 629695

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