Background: Diabetes care educational programs are advocated especially for lower-middle income countries to improve management outcomes of the disease. However, the challenge is behavioural change wheel (BCW) of the stakeholders including the quartet of ministry of health, hospital management board, healthcare professionals (HCP) and diabetes patients. 
Aim: The study investigated perception of stakeholders towards scaling-up of diabetes intensive peer-education care.
Methods: The descriptive study employed an opportunistic and purposive sampling designs. The opportunistic study was carried out in Novena University among stakeholders who attended take-off workshop of the Bringing Research in Diabetes to Global Environments and Systems (BRIDGES 2) program. The data collected were quantitative and qualitative, using a standard questionnaire to assess perceptions of ‘capacity, motivation and opportunity’ on Likert scale of ‘poor, fair or good’. Verbal responses of the respondents in the workshop group discussions were documented. Purposive survey involved ‘N = 85’ who attended ‘training the trainers’ workshops at five health facilities from 18/12/2018 – 15/01/2019. Comments of HCP about patients’ behaviour were noted. The collected data were analysed thematically and using Microsoft Excel.
Results: The respondents in opportunistic survey were ‘N = 46’. On average, the distribution of responses  on perception of capacity, motivation and opportunity were [Poor 18%, Fair 41%, Good 41%], [Poor 74%, Fair 24%, Good 2%] and [Poor 32.6%, Fair 39.5%, Good 27.9%], respectively. Suggested ways of improving BCW in the state include increased allocation of resources to the ministry of health, training and retraining healthcare professionals as well as development of reference charts for BMI and gestational weight gain. In the purposive survey, it was noted that 62.5% of civil servants attending government clinic dissented from participating in peer-education network out of fear that their employers/supervisors would know they had diabetes. Tackling socio-cultural beliefs, ignorance, poverty and taboos associated with management of the disease were suggestions for advocacy.
Conclusion: Scaling-up and sustaining diabetes care peer-educational program in Delta State is the responsibility of government and all stakeholders. The opportunities vis-à-vis facilities are available but there is need to enhance advocacy for capacity/knowledge and attitude/motivation of all stakeholders including healthcare professional, health service managers and diabetics in order to advance BCW. For instance, assessment and proper documentation of patients’ weight may be attributable to healthcare personnel’s attitude, but providing the reference chart can enhance motivation. Lack of knowledge of the individuals living with diabetes translates to limited capacity for self-management. Yet, re-training community healthcare workers can enhance informal peer-education process to mitigate lack of knowledge.

International Diabetes Federation Congress 2019