방글라데시 농촌 지역보건인력 기반 사회·행동변화커뮤니케이션 개입의 당뇨환자 건강행동 실천 효과성: 혼합연구모형

Abstract

Objectives: This study evaluated the effectiveness of a Social and Behavioral Change Communication (SBCC) intervention that combined self-management education and counseling by community health workers (CHWs) for diabetes patients in rural Bangladesh. Methods: A mixed-methods design was employed. Quantitative analysis applied propensity score matching with difference-in-differences models to compare changes in diabetes knowledge, self-efficacy, and self-management practices between the intervention and control groups. Qualitative data were collected through semi-structured interviews and analyzed thematically to identify contextual factors influencing intervention uptake and sustainability. Results: The quantitative findings revealed significant improvements (p<.001) in knowledge, self-efficacy, and self-management practices in the intervention group. Behavioral changes were particularly noted in blood glucose monitoring, dietary management, and healthcare utilization. The qualitative results emphasized that CHWs provided emotional support, practical guidance, and motivational reinforcement, which facilitated sustained self-management. Conclusion: CHW-based SBCC interventions effectively improve diabetes self-management in low- and middle-income settings. This study provides empirical evidence supporting the integration of multi-level SBCC strategies into community health systems and offers policy implications for strengthening preventive healthcare and institutionalizing CHW-led interventions.