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Nurse-led mobile phone intervention to promote self-management in type 2 diabetes in Ghana: a randomised controlled trial Ernest Asante (3822334) PUREID: 648793331 Ghana intervention mobile phone nurse self-management type 2 diabetes mellitus Introduction: Type 2 diabetes mellitus (T2DM) is an evolving global health challenge associated with unhealthy lifestyle and behaviour patterns. Individuals living with poorly managed T2DM and not adhering to treatment guidelines are at risk of developing life-threatening diabetes complications. Diabetes, more predominant in urban than in rural Ghanaian communities, is one of the leading causes of morbidity and mortality among the Ghanaian adult population. Diabetes management is a burden challenging the Ghanaian economy and healthcare system, already dealing with competing healthcare demands with limited resources. Many Ghanaian T2DM patients have poor glycaemic control and, therefore, need affordable diabetes self-management education and support (DSMES) interventions to promote their effective self-management. A small-scale nurse-led mobile phone intervention (NMPI) was designed and piloted to assess the feasibility, acceptability, and effectiveness in supporting and reinforcing adherence to treatment guidelines in Ghanaian communities. However, the pilot trial identified some limitations in the research process and intervention delivery. This PhD study aimed to refine further and assess the effectiveness of the NMPI programme in promoting glycaemic control and adherence to self-management guidelines among T2DM patients in an urban area in Ghana. Methods: The initial design of the NMPI programme and conduct of the pilot trial was guided by the UK Medical Research Council framework for complex interventions. The further refinement of the NMPI programme, underpinned by the transtheoretical behaviour 16 change model, and subsequent conduct of the randomised controlled trial (RCT) assessing the effectiveness of the NMPI programme in Ghana was guided by the findings of the pilot and a systematic review and meta-analysis of RCTs evaluating the effectiveness of clinician-led telephone DSMES interventions. Results: The pilot trial found that the novel NMPI programme is feasible, acceptable and effective in supporting and reinforcing adherence to treatment guidelines in-between clinic visits in Ghana. The systematic review and meta-analysis revealed that clinician-led telephone interventions essentially promote adherence to self-management practices, moderately impact glycaemic control and systolic blood pressure, and marginal impact anthropometric measurements among T2DM patient populations. It was also revealed that such interventions are lacking in the particularly Sub-Saharan Africa (SSA), healthcare settings. The results of the RCT assessing a refined NMPI programme showed that the intervention improves glycaemic control and adherence to self-management guidelines among people living with poorly managed T2DM in Ghana better than usual care, as hypothesised. Conclusion: The research work undertaken in this PhD study has made several contributions to knowledge. First, it piloted a novel nurse-led intervention to support T2DM self-management in a resource-limited healthcare setting like Ghana, knowledge that was previously unknown. Second, it has provided an updated summary of evidence globally on the effectiveness of clinician-led telephone DSMES interventions in promoting glycaemic control, adherence to self-management practices and impact on cardiovascular risk factors such as systolic blood pressure, serum lipoprotein profiles and anthropometric measurements among T2DM patient populations. Third, to my knowledge, this is the first study to trial a nurse-led mobile phone intervention (NMPI) to improve glycaemic control and adherence to self-management practices among T2DM patients in Ghana and SSA. Lastly, this study has resulted in the development of the NMPI programme, highlighting its potential to be integrated into Ghanaian and similar resource-limited healthcare settings to promote chronic disease management using a real-world implementation science framework. 2026-10-01T16:22:42Z Text Thesis 10.17034/32641518.v1 https://figshare.com/articles/thesis/Nurse-led_mobile_phone_intervention_to_promote_self-management_in_type_2_diabetes_in_Ghana_a_randomised_controlled_trial/32641518 All Rights Reserved