Acceptability of Positive Deviance Mentorship for Diabetes Management among HIV Clients Living with Diabetes in Eastern Uganda a Cross-Sectional Study

Introduction: The high risk of PLHIV on ART to become diabetes clients and to develop metabolic disorders is well investigated. Regular monitoring and health care is an essential requirement. A majority of HIV clients living with diabetes have poor diabetes knowledge and poor treatment outcomes. Positive deviance mentorship may be a better option for improving diabetes knowledge and treatment outcomes among registered HIV clients living with diabetes. Assessing the acceptability of public health interventions is key to understanding their potential for long-term success and feasibility. Limited literature exists about the acceptability of positive deviant mentorship (PDM) for improving knowledge and treatment outcomes among HIV clients living with diabetes. The findings of this study provide additional important insights for improving future positive deviance HIV and diabetes interventions and enhancing health programs and sustainability.

Aim: This study, conducted in October 2024, quantitatively evaluated the acceptability of the positive deviant mentorship for improving knowledge and treatment outcomes among diabetes clients living with HIV (mentees) exposed to PDM for three months (July to September) in Eastern Uganda.

Study Design: In October 2024, a cross-sectional survey was conducted in Mbale and Soroti Regional Referral Hospitals in Eastern Uganda.

Materials and Methods: The sample size was twenty-two registered participants exposed to PDM for three months. Purposive sampling was done to select eligible registered exposed participants. Electronic data collection was done using a structured questionnaire by trained research assistants. The twenty-two participants were asked to rate their agreement with various statements regarding the PDM's perceived satisfaction, effectiveness, and cultural suitability. All the research assistants were trained in data quality management. Ethical approval was obtained from Busitema University REC. Stata version 15 was used for analysis. Descriptive statistics (frequencies and percentages) were employed, to summarise the acceptability scores.

Results: All the 22(100%) participants participated in the study. The majority (77.3%) were above the age of 50 years, 54.6% were married, and only 13.6% had tertiary education. More than half of the participants, 54.5%, were employed, and a relatively large proportion, 59.1%, lived within a radius of 5 km from the nearest Health facility. The Muslims were only 31.8% and 45.4% of the participants' source of funds when sick was salary or business. A majority of the participants 95.5% were satisfied (very satisfied/satisfied) with positive deviant mentorship(intervention) and 95.4% would recommend the interventions to other HIV clients with low diabetes knowledge and poor glycemic control. A large proportion of the participants 91% perceived the intervention as feasible and effective in achieving its goals. Almost all the participants 95.5% felt the intervention was culturally appropriate for them.

Conclusions: The study revealed that Positive deviant mentorship is highly acceptable among the research participants in Soroti and Mbale Hospitals Eastern Uganda. The positive deviant mentorship-prescribed activities were easy to do and were culturally appropriate. This intervention is recommended for HIV clients living with diabetes who have low diabetes knowledge and poor glycemic control in similar contexts.

This study's limitations include selection bias, recall bias, a cross-sectional design, and a small sample size. These were mitigated during the data collection, mentorship and analysis process.