Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability

Background: Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. Methods: In five steps, we: 1. Clarified the principles of supported self-management as reported in the published literature 2. Identified the barriers to effective self-management of type 2 diabetes in adults with a learning disability 3. Reviewed existing materials that aim to support self-management of diabetes for people with a learning disability 4. Synthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to them 5. Implemented and field tested the intervention Results: The final intervention had four standardised components: (1) establishing the participant’s daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals. Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions. Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. Conclusions: The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. Trial registration: Current Controlled Trials ISRCTN41897033 (registered 21/01/2013)

Negotiating treatment for hepatitis C: Interpersonal alignment in the clinical encounter

Antiviral treatment for hepatitis C constitutes a considerable physical and psycho-social challenge without guarantee of treatment success. Using semi-structured in-depth interviews, this article investigates the experiences of people on hepatitis C treatment and the experiences of physicians who care for people with hepatitis C. Given the importance of the interpersonal dimension of the patient—physician relationship for patients accessing treatment, adhering to treatment, dealing with treatment side-effects and completing treatment, the article focuses on the interpersonal dimension of patients’ and physicians’ accounts. The theoretical foundation is ‘appraisal’ theory from systemic functional linguistics, which is grounded in Bakhtin’s notions of heteroglossia and dialogism. The article describes the intersubjective stances that patients and physicians adopt in accounts of their interactions about hepatitis C treatment, the values they construct and the semantic backdrop against which these meanings are constructed. The article traces the semantic patterns of intersubjective alignment and disalignment between patients and physicians, as well as the semantics of patients’ challenging the intersubjective stances taken by their physicians. While the biomedical discourse was intersubjectively at odds with the experiences of some patients, others aligned with it. In fact, understanding and speaking the language of biomedicine enabled some patients to challenge the traditional doctor—patient relationship and to reconfigure it into a partnership approach

Multi-generational Workforce and Its Implication for Talent Retention Strategies

Talent recruitment and retention research has traditionally looked at such characteristics as age, gender, ethnicity, tenure, and more. There is however an increasing demand to add multigenerational diversity to this list. The current multi-generational workforce of Silent Generation, Baby Boomers, Generation X, and the Millennials generates a need for organizations to manage a highly diverse set of employees whose work habits and expectations vary widely. A generic approach to attracting and managing this multi-generational type of workforce is unlikely to work, mostly due to markedly distinct needs and wants by each generation. To keep up with multi-generational workforce, organizations need to respond to these varying needs and develop innovative ways to attract, manage, and retain talents. This chapter will give insight into the most effective talent management and retention practices per each generation and contextualize them in relation to stability of work environments

Cost and profit efficiency of conventional and Islamic banks in GCC countries

Banking, Cost efficiency, Profit efficiency, Islamic banks, Stochastic frontier approach, GCC countries, C30, G21,