Validity and reliability of the DMSES UK : a measure of self-efficacy for type 2 diabetes self-management

Objectives Self-efficacy is an important outcome measure of self-management interventions. We aimed to establish UK validity and reliability of the diabetes management self-efficacy scale (DMSES). Methods The 20 item DMSES was available for Dutch and US populations. Consultation with people with type 2 diabetes and health professionals established UK content and face validity resulting in item reduction to 15. Participants were adults with type 2 diabetes enrolled in a randomised controlled trial (RCT) of the diabetes manual, a self-management education intervention, with an HbA1c over 7% and who understood English. Baseline trial data and follow-up control group data were used. Results A total of 175 participants completed all 15 items. Pearson’s correlation coefficient of −0.46 (P 0.30. Cronbach’s alpha was 0.89 over all items. Conclusion This evaluation demonstrates that the scale has good internal reliability, internal consistency, construct validity, criterion validity, and test-retest reliability. Practice Implications The 15 item DMSES UK is suitable for use in research and clinical settings to measure the self-efficacy of people living with type 2 diabetes in managing their diabetes

Stakeholder perspectives on the development of a virtual clinic for diabetes care : qualitative study

Background: The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users. Objective: The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management. Methods: Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized. Results: Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described. Conclusions: Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study

The Diabetes Obstacles Questionnaire

The Diabetes Obstacles Questionnaire (DOQ) is designed for completion by people who have Type 2 diabetes. There are 8 SCALES, with several ITEMS in each scale. Each scale deals with one topic and comprises a number of items. Each item deals with one obstacle in that topic. Each item should be answered by ticking one box. For an individual who has Type 2 diabetes, not all scales may be relevant, so a selection of which scales to use can be made either by the person, or by his or her clinician. Having selected the scales to be used, all items on a scale should be answered. The items are deliberately all related to obstacles and so may seem to have a negative tone to them. The items are designed to identify the obstacles for an individual person. The obstacles are those items for which the respondent has ticked the box for Agree or Strongly Agree. In a clinical setting this could then lead to the obstacles being addressed. In a research setting, the scales may be used to demonstrate change in obstacles, perhaps due to an intervention intended to reduce obstacles

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

The Diabetes Manual trial protocol – a cluster randomized controlled trial of a self-management intervention for type 2 diabetes [ISRCTN06315411]

Background The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinically effective 'Heart Manual'. The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory. It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care. Methods/design In a two-group cluster randomized controlled trial, GP practices are allocated by computer minimisation to an intervention group or a six-month deferred intervention group. We aim to recruit 250 participants from 50 practices across central England. Eligibility criteria are adults able to undertake the programme with type 2 diabetes, not taking insulin, with HbA1c over 8% (first 12 months) and following an agreed protocol change over 7% (months 13 to 18). Following randomisation, intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants. Deferred intervention nurses receive the training following six-month follow-up. Primary outcome is HbA1c with total and HDL cholesterol; blood pressure, body mass index; self-efficacy and quality of life as additional outcomes. Primary analysis is between-group HbA1c differences at 6 months powered to give 80% power to detect a difference in HbA1c of 0.6%. A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes, and a qualitative study is running alongside. Discussion This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes. The trial will increase our understanding of intervention transferability between conditions, those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes

Modelling of human mechanical and subjective responses to vibratory forces

A very common activity of human beings is travelling. Whether it be by baby-sling, wheelchair, skis, car, boat, aircraft or on foot, most people have experienced some form of transport. The movement involved in this transportation is usually forwards but other motions also occur in the vertical and lateral directions. It is with the vertical movements experienced in transport and the response to them that this study is concerned. [Continues.

Older patients’ involvement in their healthcare: can paper based tools help? A feasibility study in 11 European countries

Three paper-based tools to enhance older patients’ involvement in general practice care have been used and evaluated by 63 general practitioners (GPs) and 351 patients in 10 European countries and Israel within the IMPROVE project. In all countries the tested tools were helpful for some patients, by encouraging them to ask questions, address important issues and offer their own opinions. In none of the participating countries were the tools suitable to be used universally with all older patients, and sometimes they even hindered patient involvement. In everyday practice, tools may be used from time to time, in order to remind and motivate older patients and their GPs to pay more attention to the patient’s view. GPs should tailor the choice and the use of any instrument to the individual patient, and it should be the patient’s choice whether to use a specific tool or not