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Lawton J, Chadwick PM, de Zoysa N, Stanton-Fay S, Heller SR, Rankin D. Participants' experiences of attending a structured education course (DAFNEplus) informed by behavioural science. Diabet Med 2024; 41:e15309. [PMID: 38361333 DOI: 10.1111/dme.15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
AIMS As part of a broader process evaluation, we explored participants' experiences of, and engagement with, the DAFNEplus programme's group-based structured education course. This course, which was informed by behavioural science, provided participants with education and instruction to use flexible intensive insulin therapy (FIIT) together with techniques to identify and address unhelpful cognitive and emotional influences on their type 1 diabetes self-management. METHODS We interviewed n = 28 DAFNEplus participants. Data were analysed thematically and took account of previous work exploring individuals' experiences of standard DAFNE courses. RESULTS As well as benefitting from the DAFNEplus course's skills-based training and educational curriculum, participants' accounts suggested they had experienced cognitive and emotional changes that had positively influenced their confidence and motivation to adopt and sustain the use of FIIT. These benefits were most keenly felt by those who reported negative emotional states and mind-sets pre-course which had made their diabetes self-management challenging. Participants' cognitive and emotional changes were enabled through techniques used during the course to normalise setbacks and imperfect diabetes self-management, capitalise upon group synergies and encourage the use of social support, including from healthcare professionals. Participants also highlighted motivational gains arising from being reassured that diabetes complications are not common or inevitable if a FIIT regimen is followed. CONCLUSIONS Our findings suggest that offering training in FIIT, in conjunction with behaviour change techniques that target unhelpful mindsets and emotional resilience, may be more effective in promoting diabetes self-management than offering education and skills training alone.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | - Paul M Chadwick
- UCL Centre for Behaviour Change, University College London, London, UK
| | | | | | - Simon R Heller
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
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Leksell J, Toft E, Rosman J, Eriksson JW, Fischier J, Lindholm-Olinder A, Rosenblad A, Nerpin E. Virtual clinic for young people with type 1 diabetes: a randomised wait-list controlled study. BMC Endocr Disord 2023; 23:255. [PMID: 37990315 PMCID: PMC10664359 DOI: 10.1186/s12902-023-01516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1. METHODS 79 participants with type 1 diabetes aged 18-25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months. RESULTS Baseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life. CONCLUSIONS The implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management. TRIAL REGISTRATION ISRCTN number: 73,435,627 (registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627 . The performance and results of this trial adhere to the guidelines outlined in the CONSORT 2010 (Consolidated Standards of Reporting Trials) recommendations.
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Affiliation(s)
- Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden.
| | - Eva Toft
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Diabetes Unit, Ersta Hospital, Stockholm, Sweden
| | - Jessica Rosman
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
| | - Johan Fischier
- Diabetes Unit, Karolinska University hospital, Stockholm, Sweden
| | - Anna Lindholm-Olinder
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Andreas Rosenblad
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Elisabet Nerpin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Medical Sciences, Respiratory Medicine, Allergy and Sleep, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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