Young people with type 1 diabetes and their transition to adult services.

More than 85% of children and young people with type 1 diabetes are not achieving the recommended target of <7.5% HbA1c and are at risk of developing long-term complications. The delivery of care, including the transition process, is a potential contributory factor towards such poor outcomes. The emphasis needs to be on joint multi-disciplinary working across all health sectors, including primary and secondary care, in order to ensure that young people receive the right support. This has important implications for the community nurse, who needs to take a more active role in the transition of young people with type 1 diabetes to adult services, especially given the emphasis on managing long-term conditions in the community. This article focuses on the results of a research study that examined the transition of young people with type 1 diabetes and looks at the role of community nurses in young peoples' diabetes care

The use of telephone befriending in low level support for socially isolated older people--an evaluation.

There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007-2008. The purpose was to assess the impact of different models of telephone-based befriending services on older people's health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future--giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older people's well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships

Young people's participation in the development of a self-care intervention--a multi-site formative research study.

The poor outcomes of young people with chronic health conditions indicate that current services and self-care programmes are not meeting the needs of young people. How young people self-manage their condition impacts on long-term health outcomes, but there is little published evidence that details the development of self-care programmes and their most effective components. This article reports on an innovative formative research study, the purpose of which was to develop a self-care intervention prototype. Participants were 87 young people, aged 12-17, and seven young adult facilitators, aged 18-25, with type 1 diabetes or asthma. Each contributed to talking groups exploring themes that young people wanted to be addressed within a self-care programme. Instead of being focused on 'illness', young people's main concerns were directed toward 'life as an adolescent', while at the same time building sustainable daily routines of self-care. Overall, this article illustrates the process of initiating and implementing a developmental approach focused on young people, while also demonstrating the tailored self-care intervention that the process developed. This approach can be used to involve young people in the design and development of other conditions that rely on self-care interventions

Evaluation of the DigiBete App, a Self-Management App for Type 1 Diabetes: Experiences of Young People, Families and Healthcare Professionals

Abstract: Type 1 Diabetes (T1DM) is a public health issue for children, young people, and families (CYPF) requiring innovative interventions. The DigiBete app is a self-management and educa-tional app to help CYPF and healthcare professionals (HCPs) manage T1DM and features edu-cational advice and resources such as, guidance, quizzes, and educational and instructional videos on how to manage T1DM. To assess the impact and implementation of the app, the service level evaluation deployed a mixed-methods design. App data was captured via the DigiBete platform and an online survey with a non-probability sample of HCPs (N=178) and CYPF (N=1,165) = 1,343. Overall, 55.7% (n=512/919) of app users were female and 4,855 videos had been viewed across the participating areas, with an average of 1,213 videos per site (range 776-1,679) and 4.4 videos per app user. The most popular videos were how to give a glucagon injection and ‘My Sick Day Rules’ showing what to do when CYPF were unwell due to T1DM. Interviews (n=63) were undertaken with 38 CYPF and 25 HCPs. The findings indicate that CYPF and HCPs found the app an essential tool in the management of T1DM. CYPF. HCPs felt the app provided a val-uable educational resource in a central location and was invaluable in an emergency or unknown situation. The app was a trusted and bona-fide source of information that could be accessed at any time. HCPs validated DigiBete in helping CYPF to manage their T1DM. At the same time, the app saved services time and money and helped CYPF take back some of the control for managing their diabetes

Intervention Mapping: Physical Activity with Socially Disadvantaged Women - ePoster

Introduction Socially disadvantaged women (SDW) have lower levels of physical activity (PA), health inequalities and poorer health outcomes. These are associated with social determinants of health, e.g. Socioeconomic position and ethnic minority. Developing effective behaviour change programmes for SDW is complex due to disparities such as limited income and/or culturally inappropriate settings. These intricacies are often overlooked in PA policy. Consequently, interventions aimed at SDW often fail to show adequate reach, adoption and/or maintenance of PA. Therefore, we aim to inform policy and practice by developing needs-led PA interventions with SDW using Intervention Mapping (IM). IM begins with a needs assessment and follows an iterative six step process for planning interventions. Method Needs assessment tasks involved regular researcher participation in local PA sessions with SDW. The researcher also conducted 17 semi-structured interviews with SDW and community PA practitioners on the topic of PA. This data was thematically analysed and used within the first step of IM: to create a logic model of the PA health problem. Results Data gathered from interviews shows PA variety and suitable opportunities in Leeds and surrounding areas are lacking for SDW. These insights have demonstrated that the needs of SDW are essential to inform IM, PA policy and practice. Conclusion IM begins with a needs-led approach when tackling the health problem of inactivity for SDW. IM will continue to be used to design a comprehensive tool for practice and inform PA policy for SDW

Children's and young People's diabetes services: What works well and what doesn't?

The first year of care, post diagnosis, is pivotal for children and young people diagnosed with type 1 diabetes. This study evaluated a paediatric type 1 diabetes intervention, the ‘First Year of Care’, designed to maximise the care that newly diagnosed children and young people received. An observational mixed methods approach, underpinned by the Influencer Framework. A purposeful, non-probability sample of children and young people with type 1 diabetes and their families, and healthcare professionals were invited to take part. Data were collected through medical records of thirty-two newly diagnosed children and young people, plus thirty seven semi-structured interviews and exposure to six concurrent sources of influence through a questionnaire. For many participants, HbA1c levels were within the optimal range by the time of their first clinic visit post-diagnosis and continued to stay within this range throughout the first year of care. Healthcare professionals prioritised the ‘First Year of Care’ intervention. Positive practices included: a cohesive and collaborative approach; patient-centred care; latest health technology and embedded structured education. Unusually, different multidisciplinary team members were located in one place. Data indicated statistically significant differences in total sources of influence score (t [35] = 2.331, p = 0.026); healthcare professionals’ scores were higher compared to children. This suggests that children and young people have less social capital to self-manage their diabetes effectively. Greater encouragement and assistance from healthcare professionals and social networks may be needed. This paper identifies contemporary issues in practice and highlights the strengths and challenges for a paediatric diabetes intervention. The findings confirm the potential of layered approaches to behaviour change in managing type 1 diabetes across multiple domains of influence. Our study strongly suggests enhancing social motivation among children, young people and families to support successful long-term engagement in a paediatric diabetes intervention. Findings demonstrate healthcare professionals are key in delivering the intervention, along with opportunities to improve patient care, experience and outcomes

Methods of producing new nutrient data for popularly consumed multi ethnic foods in the UK

Minority ethnic groups in UK disproportionately suffer from nutrition related diseases compared to the mainstream population, contributing to widening health inequalities. However, reliable nutrient composition data of the traditional foods of these ethnic groups, which play an important part in their diets, is lacking. This makes it impossible to provide adequate and culturally acceptable nutrition interventions to reduce prevalent metabolic disorders. This study aimed to identify and analyse popularly consumed African and Caribbean foods in the UK for macro and micronutrients. Various approaches including focus group discussions, individual interviews and 24 hr dietary recalls were used to identify traditional foods. Defined criteria were used to prioritise and prepare 33 composite samples (26 dishes, 4 snacks and 3 beverages) for nutrient analyses in a UK accredited laboratory. This study methodology is novel because it uses various approaches to generate new data of commonly consumed ethnic foods and traditional recipes. In addition, the approach used in preparation of the food samples enhanced their authenticity and representativeness compared to previously published work. This paper describes the procedures undertaken and analytical methods used to develop a multi ethnic nutrient data for inclusion in UK food composition tables

‘You get some very archaic ideas of what teaching is…’: Primary school teachers’ perceptions of the barriers to physically active lessons

Physically active lessons present a key paradigm shift in educational practice. However, little is known about the barriers to implementing physically active lessons. To address this, 31 practising primary teachers (23=female) from nine primary schools across West Yorkshire, England, were engaged in focus group interviews. Drawing on the socio-ecological model, findings revealed that barriers influencing the implementation of physically active lessons are multifaceted. Teacher’s confidence and competence, concerns over classroom space, preparation time and resources, coupled with the wider school culture that is influenced by governors and parents, reinforce a didactic approach and act as barriers to physically active lessons

The evolving role of the diabetes educator

In the UK, responsibility for providing structured education to children and young people with diabetes typically falls to paediatric diabetes specialist nurses. However, the Best Practice Tariff, which calls for all children and young people with diabetes to receive ongoing, age-appropriate structured education, means that more frequent, individualised education, over and above that provided in routine care, is required. Appointment of a dedicated diabetes educator, who is responsible for and has the capacity to develop a number of age- and maturity-appropriate programmes that can be delivered by all members of the multidisciplinary team, may be of help here. This article describes the role of diabetes educators and presents two examples of services that have appointed them