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

Improving foot self-care in people with diabetes in Ghana: A development and feasibility randomised trial of a context appropriate, family-orientated diabetic footcare intervention

ObjectiveAfrica presents a higher diabetic foot ulcer prevalence estimate of 7.2% against global figures of 6.3%. Engaging family members in self-care education interventions have been shown as effective in preventing diabetes-related foot ulcers. This study culturally adapted and tested the feasibility and acceptability of an evidence-based footcare family intervention in Ghana.MethodsThe initial phase of the study involved stakeholder engagement, comprising Patient Public Involvement activities and interviews with key informant nurses and persons with diabetes (N=15). In the second phase, adults at risk of diabetes-related foot ulcers and nominated caregivers (N = 50 dyads) participated in an individually randomised feasibility trial of the adapted intervention compared to usual care to assess feasibility outcomes, and to identify efficacy signals on clinical outcomes at 12 weeks post randomisation. Patient reported outcomes were foot care behaviour, foot self-care efficacy and caregiver diabetes distress.ResultsAdjustments were made to the evidence-based intervention to reflect the literacy and information needs and preferences of stakeholders, to develop a context appropriate diabetic foot self-care intervention. A feasibility trial was then conducted which met all recruitment, retention, data quality and randomisation progression criteria. At 12-weeks post randomisation, efficacy signals favoured the intervention group on improved footcare behaviour, foot self-care efficacy and reduced diabetes distress and diabetes knowledge. Future implementation issues to consider include adequate staff time to deliver the intervention and family members unavailability to attend in-person intervention sessions, with suggestions to consider remote delivery of the intervention. ConclusionA contextual family-oriented foot self-care education is feasible, acceptable, and may improve knowledge and self-care with the potential to decrease diabetes-related complications. The education intervention is a strategic approach to improving diabetes care and prevention of foot disease especially in settings with limited diabetes care resources. Future research will investigate the possibility of using remote delivery to better meet patient and staff needs.<br/

A cross-sectional survey of general practice health workers' perceptions of their provision of culturally competent services to ethnic minority people with diabetes

Aims To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams’ access to diabetes-training, and overall perception of cultural-competence were also assessed. Methods A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. Results Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. Key findings: (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry’s population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. Conclusions Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations

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

Press statement: Hackney Redevelopment Scheme

Objectives: To explore how people living with type 2 diabetes self-manage their condition in everyday life and the impact of the Diabetes Manual programme, a one-to-one structured educational intervention aiming to increase skills and confidence for self-management. Method: Semi-structured interviews with 12 participants on the Diabetes Manual trial, sampled purposively according to baseline self-efficacy and educational attainment. Results: When describing their experience of living with diabetes, there was little difference between intervention and control participants, although those who had received the programme talked more about the use of blood glucose self-assessment. Programme users were grouped into three categories, Programme Engagers (n = 2), Programme Browsers (n = 4) and Information Seekers (n = 6). Of the two participants engaging with the programme, one described a very positive experience, the other felt unsupported by their practice. None noticed a difference in the approach used by their health professional. Participants’ approach to the Diabetes Manual programme suggests they will continue to use it as a resource in the future. Conclusion: Participants used the Diabetes Manual programme in different ways, choosing the timing and depth of engagement. Their experience suggests that the programme requires close communication and openness towards collaborative approaches to improve skills and confidence for self-management

Usability and engagement with an online platform to support the self-management of symptoms and promote the wellbeing of people with cardiovascular disease (CVD)

Cardiovascular disease (CVD) is the leading cause of disability & mortality. Related conditions include: coronary heart disease, stroke, hypertension, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. These are conditions that can be managed but not cured. Self-management is the core of effective treatment for CVDs, but can be compromised in the presence of co-morbid depression and anxiety, which has a greater prevalence in CVD patients than in the general population. Co-morbid depression and anxiety can also exacerbate the perceived severity of physical symptoms such as chest pain, breathlessness and fatigue; this commonly leads to increased primary care and emergency department attendance. Access to effective psychological treatment for depression and anxiety for people with CVD (such as cognitive behavioural therapy delivered by the government’s Improving Access to Psychological Therapy services) is limited, waiting lists can be a problem and patients may be unwilling or unable to attend. Online-delivered interventions are a low-cost and non-stigmatising way of delivering therapy and self-management support and are easily accessed

Neurolinguistic programming: a systematic review of the effects on health outcomes

BACKGROUND: Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. AIM: To evaluate the effects of NLP on health-related outcomes. DESIGN AND SETTING: Systematic review of experimental studies. METHOD: The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. RESULTS: Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. CONCLUSION: There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes