Telecare motivational interviewing for diabetes patient education and support : a randomised controlled trial based in primary care comparing nurse and peer supporter delivery

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. Methods/Design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. Discussion and implications of the research: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications

Family Empowerment Model for Type 2 DM Management: Integration of Self care Model by Orem and Family Centered Nursing by Friedman in Sikumana Health Center-Kupang

Background. The management of Diabetes which is very complex needs full support from the family. The family has a vital role in management type 2 diabetes at home involving diabetes diet, diabetes medication management, exercise, and also visit health care services for checking blood glucose and diabetes discussion session. Unfortunately, the family is rarely Involved in the health education session. The research aimed to identify the effect of family empowerment models: Integrated self-care model by Orem and Family-Centered Nursing by Friedman in type 2 DM management in Sikumana Health Center of Kupang. Methods. The research design was pra-experimental design with "One Group Pretest - Posttest approach.  The population of this study was 30 family members with type 2 DM. The data was collected by using questionnaires to measure the family members' ability to know type 2 DM, to make a proper decision, to take care of family members in term of diabetes diet management and to use health care services. Wilcoxon signed-Rank Test is used to figure out the effect of family empowerment model to conduct five family health function. Results. The study showed that the model improved the five health function performance by family members. While Wilcoxon signed-rank test also showed there was a significant effect of family empowerment model in terms of the family's ability to recognize type 2 DM (p =0.0001), to make a right decision to take care the patient (p = 0.0005). Moreover, the models have also improved the family ability to diabetes diet management (p=0,046), to motivate the patient to do regular exercise and to uses the health care facilities (p=0,014 and 0,025 respectively). Conclusions. The study recommended to actively involve the family members to take care of type 2 diabetes patient due to it affects the entire family. The family members should be well informed so that they can improve the quality of family health

The Diabetes and WELLbeing programme: protocol of a multi-site European complex intervention study

A quasi-experimental design evaluation study examines long-term impact of the 12-week DWELL programme, a self-management intervention for people with type 2 diabetes (T2D), based on adult learning and person-centred approaches, delivered in 5 community and hospital sites in 4 European countries. Overall target is 780 people with T2D. Staff are trained in motivational interviewing, group facilitation, diabetes education, and programme approach which consists of core and ‘pick and mix’ sessions on diabetes education, physical activity, healthy eating and wellbeing. Pre-post measures are taken at baseline (T0), end-of-programme (T1), at 6 months (T2) and 12 months (T3). There is a non-equivalent control group of 190 at T2/T3. Biomedical data are collected by staff and psychosocial data are collected via self-completed validated scales. Metabolic measures include: HbA1c, BMI and waist circumference. Demographics capture: age, gender, ethnicity, household composition, education, employment, income. Psychosocial data are collected on illness perception, patient empowerment, eating behaviours, physical activity, physical/mental health status, health-related quality of life (EQ-5D), use of diabetes-related health services and self-care activities. Participant experiences are recorded via motivational interviews at T0 and T1 and focus groups at T1. Process evaluation data are collected via interviews with staff and patient ambassadors. The DWELL programme started in 2018 and results will be available in 2021. The study will produce rich data on long-term impact of intervention to allow replication and further development. It will permit cross-border conclusions on sustainability and embeddedness of model in varied service settings, and empowerment-based public health approach to T2D self-management

Improving Care for Adult Clinic Patients with a History of Poor Glycemic Control

Problem Description: Patients of one internal medicine clinic were found to have nearly twice the rate of diagnosed diabetes and poor glycemic control, when compared with national rates. Given this, certain aspects of the patient-provider dyad system, such as inadequate provider time, knowledge, and resources; may have contributed to the ability of some patients to adapt to a lifestyle with consistent diabetes self-care. Intervention: An evidence-based diabetes protocol was developed, a diabetes self-management training (DSMT) curriculum was adapted to local context, and three cycles of patient-centered DSMT classes were delivered to provide individual and group-based support to participants. Completion of the DSMT series was expected to improve diabetes empowerment, performance of self-care behaviors, and A1C levels from baseline; and result in positive program satisfaction. Draft documents were also developed to fulfill accreditation standards toward application as a Diabetes Education Center, which would allow clinic providers to receive third-party reimbursement for DSMT services. Results: During the pilot project, 16 patient referrals were received, 10 patients attended DSMT classes, and nine patients completed the 4-class series. Afterward, participants self-reported slightly increased diabetes empowerment and performance of self-care behaviors, and positive program satisfaction. Interpretation: Upon conclusion of the pilot project, it was determined that poor glycemic control did not always indicate inability to adapt to a lifestyle with diabetes; and all participants benefitted from receiving DSMT. Three-month findings were somewhat comparable to the diabetes literature at 3 and 6 months, with differences most likely due to the short series duration and 1-week interval between some DSMT classes. Positive impact for participants involved receiving evidence-based support in diabetes self-management. At 3 months, 89% of participants self-reported daily performance of SMBG and foot care; and available A1C results demonstrated reductions for 83% of participants. Positive impact for the clinic was demonstrated by the medical director stating that she would refer all of her patients with diabetes for DSMT. Implications for policy development included the clinic becoming certified as a Diabetes Education Center, and third-party payers adequately reimbursing DSMT and reducing costs for copays and supplies for diabetes self-care. Conclusions: Sustainability of the pilot project will be reached if the clinic becomes a Diabetes Education Center, assists other practices to pursue certification, and develops similar models to support patients with other chronic illnesses. Implications for further study include determining cost-effective methods to deliver DSMT classes that will result in long-term behavior change. Next steps include disseminating findings through the Boise State University Executive Session and ScholarWorks, researching smart phone apps to reinforce diabetes self-care, and starting a diabetes support group in the local area

Re-thinking technology and its growing role in enabling patient empowerment

© The Author(s) 2018. The presence and increase of challenges to eHealth in today’s society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment

"It's a whole package" : Type 2 diabetes and what it means for the body, life and self of people of Indian origin in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Psychology (with an endorsement in Health Psychology) at Massey University, Albany, New Zealand

Type 2 diabetes represents a considerable health problem for the Indian population group in New Zealand. In order to minimise the risk posed by this disease, recommended therapeutic goals include glycaemic control, maintaining a healthy weight and strict control of blood pressure. Culturally derived understandings of the illness and options for management will affect the way in which the person of Indian origin reacts to diabetes. This study looked at the way in which Type 2 diabetes is constructed and positioned while reflecting on how Indian culture might affect the way in which diabetes is interpreted and experienced. Seven males and five females, identifying themselves as being of Indian origin and managing Type 2 diabetes without the use of insulin were selected for the study. Semi-structured interviews were taped, transcribed and analysed using a reflexive approach to Foulcauldian discourse analysis Understanding diabetes begins through describing and accounting for the diabetic body which is believed to be different to other bodies. The way in which the person with diabetes might chose to control the disease and minimise harm to the body is validated by particular beliefs in cause and nature. As a result, the person with diabetes is able to construct a constantly evolving picture of the way in which the disease develops, what can be expected of it and what diabetes means for them, for their families and social connections. All this takes place within the particular social and cultural perceptual system of the person of Indian origin and the environment within which they live their every-day lives. The person with diabetes is actively engaged in processing new information, weighing options and defining who they are, not merely as someone with diabetes but as multi-dimensional individuals. Drawing on different constructions of the self, to justify and explain actions taken, opens up or limits access to opportunities to make changes and embrace new behaviors to manage their diabetes

The Effect of a Group Lifestyle Coaching Model on HbA1c and Psychosocial Constructs in Low-Income Patients with Type 2 Diabetes

The epidemic of diabetes and its complications is concerning, and new approaches need to be explored for fostering better patient outcomes in a cost effective way. This exploratory study examined the effectiveness of a group coaching model on glycemic control, diabetes knowledge, diabetes empowerment, and diabetes self-management compared to usual care or participation in a 90-minute diabetes education class. A convenience sample of 34 patients with type 2 diabetes mellitus was recruited at a clinic providing services to the uninsured. Participants self-selected into the coaching group (n= 12), class group (n = 10), or control group (n = 12). HbA1c and four psychosocial questionnaires were used in a repeated measures pre-test/post-test design. ANOVA, Kruskal-Wallis, paired-samples t test, Wilcoxon signed-rank test, ANCOVA, Pearson\u27s product-moment correlation, and hierarchical multiple regression were used to examine relationships among the variables. Although results suggest that the coaching model did not improve glycemic control or the psychosocial indices measured, the coaching group had the least weight gain over the course of the study (.55 lbs ± 5.55). The contribution of the intervention group to the change in body weight remained significant even after adjusting for age, medication changes, and years with diabetes (R2 = .416, F(4,18) = 3.201, p \u3c .0005; adjusted R2 = .286). A post-program evaluation completed by the coaching group revealed a positive group experience and several positive health behavior changes. Further research with a larger sample and longer time-frame would be beneficial to expand on this approach to diabetes care and diabetes self-management education

A psychological approach to providing self-management education for people with type 2 diabetes : the diabetes manual

Background: The objectives of this study were twofold (i) to develop the Diabetes Manual, a selfmanagement educational intervention aimed at improving biomedical and psychosocial outcomes (ii) to produce early phase evidence relating to validity and clinical feasibility to inform future research and systematic reviews. Methods: Using the UK Medical Research Council's complex intervention framework, the Diabetes Manual and associated self management interventions were developed through preclinical, and phase I evaluation phases guided by adult-learning and self-efficacy theories, clinical feasibility and health policy protocols. A qualitative needs assessment and an RCT contributed data to the pre-clinical phase. Phase I incorporated intervention development informed by the preclinical phase and a feasibility survey. Results: The pre-clinical and phase I studies resulted in the production in the Diabetes Manual programme for trial evaluation as delivered within routine primary care consultations. Conclusion: This complex intervention shows early feasibility and face validity for both diabetes health professionals and people with diabetes. Randomised trial will determine effectiveness against clinical and psychological outcomes. Further study of some component parts, delivered in alternative combinations, is recommended