**3. Developing diabetes interventions**

Various studies have reported poor diabetes outcomes among patients [13, 14], including rising prevalence rates. This calls for new interventions and strategies to manage and curb the prevalence of diabetes. For effective intervention, developing diabetes intervention includes identifying and prioritizing health issues and needs, choosing ways to cope with them, and committing support and resources for quality health promotion activities [15]. The process of developing intervention should be an inclusive and participatory process involving the targeted group [16]. The target population should include patients living with all types of diabetes, age groups, and gender. Health needs assessment is hereby discussed as a subheading of developing diabetes intervention.

#### **3.1 Health needs assessment**

A health needs assessment is a critical and systematic approach to identifying the unmet healthcare needs of the population and making changes to meet those unmet needs [3]. In this context of diabetes management, it could be used to identify what needs to be done for better outcomes. Health needs assessments are done for the effective use of health services and resources to improve health and the quality of life of patients. A health needs assessment encourages cooperation or partnership and innovation. Needs assessments are the backbone of public health and must be conducted properly. The process of conducting a health needs assessment involves the identification of health problems and inequalities, and a determination of appropriate interventions to address the problems. The requirements for conducting successful health needs assessments are an understanding of what is involved, and the time, and resources to undertake assessments. The cost of managing diabetes and its related complications is

increasing [17]. It is essential to conduct a health needs assessment properly for effective intervention. Without a clear and well-conducted health needs assessment, intervention could result in the misuse of funds. A mixed-method needs assessment study conducted in Tanzania involving diabetes patients with retinopathy demonstrated low levels of stigma and self-efficacy along with high levels of anxiety and depression [18]. Moreover, the study showed inadequate knowledge regarding a healthy diet. On those grounds, a comprehensive diabetes education program was developed to improve diabetes control and prevent complications including retinopathy [18].

According to the WHO [19], diabetes interventions are dietary therapy, increased physical activity, and pharmacological therapy consisting of oral hypoglycaemic drugs or insulin. There is a need to empower diabetes patients and their family members with skills and knowledge related to diabetes. This would help in attaining better diabetes outcomes and an improvement of quality of life, including reducing the chances of family members developing diabetes [20]. Family members of patients diagnosed with diabetes are already at risk due to family history. In South Africa, the Department of Health adopted WHO guidelines for diabetes management [21]. However, implementation has been a challenge. A baseline analysis of factors contributing to poor implementation may be necessary. Behavioral changes among patients with diabetes are difficult to implement due to the inaccessibility of the following: healthy food, an enabling environment for physical exercise, and essential self-management resources [22]. Patients diagnosed with diabetes are from various cultural backgrounds, which influences their behavior. It is therefore essential to conduct a baseline analysis to design and develop diabetes interventions that are sensitive to cultural beliefs. Behavioral changes are influenced by factors including knowledge and attitudes [23]. Education programs incorporating behavior change approaches are extra effective. Behavioral change is a complex process and should be based on a theoretical framework. The use of theory enables a greater understanding of the relationships among factors that influence behavioral change [24].

### *3.1.1 How to conduct a health needs assessment*

According to the Centers for Disease Control and Prevention [25], there are five critical steps on how to conduct a health need assessment, which are as follows:

Plan and design: The first step involves defining the scope and objectives of the assessment. This includes defining who, what, and where.

Logistics and resources: The availability of resources impacts health needs assessment activities, so it is important to have sufficient funds to carry out the assessment. The most important resource is capacitated healthcare providers who understand the importance of the need assessment and how to conduct it.

Review and rate data: Before capturing and analyzing data, a review of the data must take place for team members to reach a consensus. At this point, the team discusses data, shares individual results, and identifies evidence to support collective rating. This step helps in identifying strengths and weaknesses.

Record and summarize data: Following an agreement on rating, data is analyzed to produce findings that will guide the action to be taken.

Action plan: Based on the findings of the data analysis, an action plan should be developed to close identified gaps. At this stage, summarized data is transformed into measurable action items.

#### *3.1.2 Components to assess during need assessment*
