Assessing self-management responses to educational interventions in at-risk diabetes population: a cluster-based longitudinal analysis

OBJECTIVES: To assess the effect of three educational interventions on self-management behaviours among individuals at risk of diabetes in Burkina Faso, Comoros and Mali, using cluster analysis to identify distinct respondent profiles. DESIGN: Single-arm before-after longitudinal study with 6-month follow-up. SETTING: Community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali. PARTICIPANTS: 540 adults at risk of diabetes (body mass index ≥25 kg/m² and/or family history of diabetes and/or impaired fasting glucose ≥1.10 g/L; mean age 38.2 years, 69% female) recruited through community screening initiatives and antenatal clinics in Burkina Faso, Comoros and Mali. INTERVENTIONS: Three educational interventions: (1) social media video broadcasting, (2) peer educator outreach and (3) gestational diabetes education at antenatal clinics. PRIMARY AND SECONDARY OUTCOME MEASURES: effect sizes. RESULTS: Of the 540 initial participants, 528 responded to the follow-up survey 6 months later. Cluster analysis revealed two distinct self-management profiles: cluster 1 showed significant improvement in only two domains, self-monitoring (d=0.35, p=0.006) and skill acquisition (d=0.30, p=0.020), indicating limited but focused gains. In contrast, cluster 2 suggested significant progress in seven out of eight domains, including large gains in positive engagement in life (d=0.74, p<0.001) and health-directed activity (d=0.61, p<0.001). Emotional distress decreased significantly in cluster 2 (d=-0.27, p=0.009), underscoring its greater responsiveness. CONCLUSION: Distinct self-management profiles among diabetes-risk populations revealed critical heterogeneity that demands tailored, context-specific public health strategies to effectively address diverse needs and optimise prevention efforts.