The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes

AIMS

To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes.

METHODS

This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes.

CONCLUSIONS

Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

Effects of web-based diabetes education on knowledge retention in adult general population: An experiment

OBJECTIVE

To conduct a study to improve diabetes knowledge through a web-based diabetes course in the general adult population. We hypothesised that participation in a web-based diabetes course would have a positive impact on diabetes knowledge retention.

METHODS

Participants were randomly assigned to an experimental or control group. Participants in the experimental group attended an interactive web-based diabetes course. The Diabetes Knowledge Questionnaire (DKQ24) was used to assess the diabetes knowledge levels. The DKQ24 was completed at the beginning and end of the observation period of 3 months. The experimental group also completed it immediately after the intervention.

RESULTS

At the end of the observation period, a statistically significant difference in the mean rank of DKQ24 scores was found in favor of the experimental group (p < .001). The results of the experimental group had a lower interquartile range (IQR = 3) than those of the control group (IQR = 5).

CONCLUSIONS

This study suggests that providing a web-based diabetes course to the general population is effective and can improve diabetes knowledge and retention.

A critical realist exploration of factors influencing engagement in diabetes prevention programs in rural settings

BACKGROUND

Diabetes prevention programs are intended to reduce progression to type 2 diabetes, but are underutilised. This study aimed to explore people with prediabetes' knowledge and attitudes about prediabetes, and their perceptions about engagement in preventive programs in a rural setting. The findings will inform strategies and recommendations to increase preventive health program engagement.

METHODS

Using a qualitative approach with a critical realist methodology, semi-structured interviews were conducted with 20 rural participants with prediabetes from the Northern New South Wales Local Health District in 2021. Interviews were audio-recorded, transcribed verbatim and thematically analysed. The social-ecological model was used as a framework to interpret and action the study findings.

RESULTS

Factors that empowered participants and facilitated a desire to engage in preventive programs included knowledge about prediabetes, a high level of social support, trusting and supportive relationships with health professionals, and a strong desire not to progress to diabetes. Barriers to program engagement included low health literacy levels, limited support, negative experiences with health services, and social and physical constraints. The factors that influenced engagement with preventive health programs were mapped to an individual, interpersonal, organisational, community and policy level, which highlighted the complex nature of behaviour change and the influence of underlying mechanisms.

CONCLUSIONS

Engagement in diabetes prevention programs was dependent on individual agency factors and structural barriers, each of which related to a level of the social-ecological model. Understanding the perceptions of people with prediabetes will inform strategies to overcome multi-level barriers to preventive health program engagement in rural settings.

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ)

BACKGROUND

Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role.

METHODS

A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated.

RESULTS

Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers.

CONCLUSIONS

Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

Theory-informed strategies to address factors anticipated to influence implementation and people's participation in community pharmacy-based diabetes prevention services

Background

Early identification of non-diabetic hyperglycaemia and implementation of diet and lifestyle changes can prevent type 2 diabetes. However, low participation in diabetes prevention services remains a problem in the UK. The community pharmacy, one of the most accessible healthcare settings in the UK, could provide one solution to improving participation.

Aim

To prioritize factors that could influence delivery of, and people-participation in, community pharmacy-based diabetes prevention services, and to identify strategies to facilitate successful implementation.

Methods

A mixed-methods, primary care-based study, comprising of two stages: 1- Prioritizing key influences of participation and delivery using a structured Nominal Group Technique with people with non-diabetic hyperglycemia, and other stakeholders; 2 - Identifying theory informed strategies to facilitate successful implementation using framework analysis. This involved mapping prioritized influences and qualitative data from the Nominal Group Technique onto the Behaviour Change Wheel theoretical framework. The study was conducted in February 2019, in Norfolk, UK and ethical approval obtained prior to research commencing.

Results

Fifteen participants (five people with non-diabetic hyperglycaemia, nine community pharmacy and general practice staff and one commissioner) participated. Participants prioritized "awareness" and "service integration" as key factors likely to influence participation and "the provision of information about health consequences e.g., leaflets" and "action planning e.g. general practice referral of patients to prevention services" as key strategies to facilitate participation. "Training", "staffing levels" and "workload" were amongst the key factors prioritized as most likely to influence delivery. Strategies identified to facilitate implementation included "instructions of how to perform the behaviour e.g. standard operating procedures" and "reward e.g. funding".

Conclusions

This research provides theory informed strategies needed to facilitate successful implementation of community pharmacy-based diabetes prevention services. The findings of this study should inform the design of future diabetes prevention services to ensure participation and sustainability.

The English national health service diabetes prevention programme (NHS DPP): A scoping review of existing evidence

AIMS

The English National Health Service Diabetes Prevention Programme (NHS DPP) is commissioned by NHS England and has been rolled out across England to adults identified as being at high risk of type 2 diabetes. The present scoping review aimed to identify the extent and nature of evidence to date on the NHS DPP and describe what the evidence has reported.

METHODS

A scoping review involving searches of various sources (including MEDLINE, CINAHL, MediArXiv, Google Scholar and GreyLit) was conducted on 31 August 2021 and repeated on 09 February 2022. Only articles reporting on the NHS DPP made available since 2015 were eligible for inclusion.

RESULTS

65 articles were included. Of these, 37 were journal publications. Most articles were made available in 2018 and 2020 (total n = 25). The majority of articles reported on uptake and retention (n = 27) whilst others reported on implementation considerations (n = 24), programme outcomes (n = 21), stakeholder experience (n = 8) and screening and referral processes (n = 3). Various research methods were reported and included qualitative (n = 9) and document analysis (n = 8). Articles revealed preliminary evidence on service user characteristics, rates of referral, uptake and retention as well as how far the NHS DPP is being delivered in line with its evidence base and service specification.

CONCLUSIONS

The evidence is accumulating on NHS DPP uptake and retention most, with emerging evidence on programme outcomes (such as weight loss and HbA1c). More evidence is warranted on stakeholder experience to decipher how to overcome low initial and long-term engagement reported by the current evidence base.

Facilitators and barriers for lifestyle change in people with prediabetes: a meta-synthesis of qualitative studies

BACKGROUND

The increasing prevalence of type 2 diabetes worldwide is a major global public health concern. Prediabetes is a reversible condition and is seen as the critical phase for the prevention of type 2 diabetes. The aim of this study is to identify and synthesize current evidence on the perceived barriers and facilitators of lifestyle change among people with prediabetes in terms of both initial change and lifestyle change maintenance.

METHODS

A systematic literature search in six bibliographic databases was conducted in April 2021. Potential studies were assessed for eligibility based on pre-set criteria. Quality appraisal was done on the included studies, and the thematic synthesis approach was applied to synthesize and analyse the data from the included studies.

RESULTS

Twenty primary studies were included, containing the experiences of 552 individuals. Thirteen studies reported participants perceived facilitators and barriers of lifestyle change when taking part in community-based lifestyle intervention programs, while seven studies reported on perceived facilitators and barriers of lifestyle change through consultations with health care professionals (no intervention involved). Three analytical themes illuminating perceived barriers and facilitators for lifestyle change were identified: 1) the individual's evaluation of the importance of initiating lifestyle change, 2) the second theme was strategies and coping mechanisms for maintaining lifestyle changes and 3) the last theme was the significance of supportive relations and environments in initiating and maintaining lifestyle change.

CONCLUSION

Awareness of prediabetes and the perception of its related risks affects the motivation for lifestyle change in people at risk of type 2 diabetes; but this does not necessarily lead to lifestyle changes. Facilitators and barriers of lifestyle change are found to be in a complex interplay within multiple ecological levels, including the interpersonal, intrapersonal, environmental and policy level. An integrated understanding and analysis of the perceived barriers and facilitators of lifestyle change might inform people with prediabetes, healthcare professionals, and policy makers in terms of the need for psychological, social, and environmental support for this population.

An ounce of prevention is worth a pound of cure: considerations for pharmacists delivering the National Diabetes Prevention Program

Prediabetes is highly prevalent in the United States affecting over 88 million adults. In 2010, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program (NDPP), an intensive lifestyle program consisting of a 16-lesson curriculum focused on diet, exercise, and behavior modification, with the ultimate goal to reduce progression from prediabetes to diabetes. Despite tens of millions of adults potentially qualifying to participate in the program, the uptake of the NDPP has been exceedingly low. As a result, the CDC has focused its efforts on engaging with local health departments and community partners, including community pharmacies, across the United States to scale-up enrollment in the NDPP. In this commentary we discuss factors affecting implementation of the NDPP in community pharmacies and other settings where pharmacists practice, including training, space, personnel, recruitment and enrollment, retention, and sustainability.