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Influence of Community-Based Diabetes Screening on Diabetes Detection among Adults in Nigeria

Abstract

Diabetes mellitus is a major public health challenge in Nigeria and is increasingly contributing to premature illness, disability, and mortality among adults. The condition may remain undiagnosed for prolonged periods because some individuals do not experience noticeable symptoms during the early stages of the disease. Late detection may delay appropriate management and increase the risk of complications affecting the cardiovascular system, kidneys, eyes, nerves, and other organs. Community-based diabetes screening provides an opportunity to identify adults with elevated blood glucose levels or possible diabetes outside conventional hospital settings and facilitate timely referral for confirmatory assessment and appropriate care. Community screening may be delivered through primary healthcare centres, community outreach programmes, health campaigns, mobile screening activities, workplaces, markets, religious centres, and other community platforms. Diabetes detection refers to the identification of individuals with possible or confirmed diabetes through appropriate screening and subsequent diagnostic assessment. In Nigeria, barriers such as limited awareness, geographical distance from health facilities, financial constraints, inadequate screening services, and shortage of healthcare personnel may contribute to delayed detection. Against this background, this study investigates the influence of community-based diabetes screening on diabetes detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Health Systems Framework. The Health Belief Model explains health-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action and provides a framework for understanding adults' participation in diabetes screening. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a basis for understanding how accessible community screening services may influence diabetes detection. The Health Systems Framework emphasizes service delivery, health workforce, health information, health technologies, financing, and accessibility as important components of effective healthcare delivery. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based diabetes screening may influence diabetes detection among adults in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, community screening locations, and eligible participants. Community-based diabetes screening will be assessed using indicators such as availability of screening services, frequency of screening activities, accessibility of screening locations, availability of trained screening personnel, availability of appropriate blood glucose testing equipment, screening coverage, community mobilization, health education, confidentiality, referral services, confirmatory testing arrangements, and continuity of screening activities. Diabetes detection will be assessed using indicators such as completion of diabetes screening, identification of individuals with elevated blood glucose levels, referral for confirmatory testing, newly identified diabetes cases, and completion of diagnostic assessment. Data will be collected using structured questionnaires, screening records, community health-worker records, referral registers, healthcare facility records, and relevant programme documents where available. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, and diabetes detection patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of community-based diabetes screening on diabetes detection. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that community-based diabetes screening has a significant positive influence on diabetes detection among adults in Nigeria. Adults who have access to regular and accessible community-based screening are expected to have a greater likelihood of having previously undiagnosed diabetes or elevated blood glucose levels identified than adults who do not participate in community screening. Bringing screening services closer to communities may reduce geographical, financial, and logistical barriers and provide opportunities for individuals who may not routinely visit healthcare facilities to undergo assessment. Community health education and mobilization may also increase awareness of diabetes risk factors and the importance of early detection. Timely referral of individuals with abnormal screening results for confirmatory testing may further improve the identification of previously undiagnosed diabetes cases. Conversely, inadequate screening coverage, shortages of trained personnel, limited testing equipment, poor referral systems, lack of confirmatory testing, and low community participation may reduce the effectiveness of community-based screening. However, community-based screening alone may not fully determine diabetes detection because individual health awareness, perceived risk, socioeconomic circumstances, healthcare-seeking behaviour, family history, and accessibility of diagnostic and treatment services may also influence detection. The study is expected to contribute to the literature on community-based diabetes screening, diabetes detection, noncommunicable disease prevention, early diagnosis, community health, primary healthcare, epidemiology, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, noncommunicable disease programme managers, primary healthcare facilities, community health workers, healthcare professionals, development partners, and policymakers regarding strategies for improving early detection of diabetes. The study will also provide evidence-based recommendations for expanding community-based diabetes screening, increasing public awareness of diabetes, improving access to screening equipment, strengthening training of community health workers, establishing effective referral and confirmatory testing systems, integrating diabetes screening into routine primary healthcare and community outreach activities, and improving access to appropriate diabetes care following detection across Nigeria.

Keywords: Community-based diabetes screening, diabetes detection, adults, Nigeria, diabetes mellitus, noncommunicable diseases, early detection, community health, primary healthcare, diabetes screening, epidemiology, public health.