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Ross J, Cotterill S, Bower P, Murray E. Influences on Patient Uptake of and Engagement With the National Health Service Digital Diabetes Prevention Programme: Qualitative Interview Study. J Med Internet Res 2023; 25:e40961. [PMID: 36853751 PMCID: PMC10015356 DOI: 10.2196/40961] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Digital diabetes prevention programs (digital-DPPs) are being implemented as population-based approaches to type 2 diabetes mellitus prevention in several countries to address problems with the uptake of traditional face-to-face diabetes prevention programs. However, assessments of digital-DPPs have largely focused on clinical outcomes and usability among those who have taken them up, whereas crucial information on decision-making about uptake (eg, whether a user downloads and registers on an app) and engagement (eg, the extent of use of an app or its components over time) is limited. Greater understanding of factors that influence uptake and engagement decisions may support large-scale deployments of digital-DPPs in real-world settings. OBJECTIVE This study aimed to explore the key influences on uptake and engagement decisions of individuals who were offered the National Health Service Healthier You: Digital Diabetes Prevention Programme (NHS-digital-DPP). METHODS A qualitative interview study was conducted using semistructured interviews. Participants were adults, aged ≥18 years, diagnosed with nondiabetic hyperglycemia, and those who had been offered the NHS-digital-DPP. Recruitment was conducted via 4 providers of the NHS-digital-DPP and 3 primary care practices in England. Interviews were conducted remotely and were guided by a theoretically informed topic guide. Analysis of interviews was conducted using an inductive thematic analysis approach. RESULTS Interviews were conducted with 32 participants who had either accepted or declined the NHS-digital-DPP. In total, 7 overarching themes were identified as important factors in both decisions to take up and to engage with the NHS-digital-DPP. These were knowledge and understanding, referral process, self-efficacy, self-identity, motivation and support, advantages of digital service, and reflexive monitoring. Perceptions of accessibility and convenience of the NHS-digital-DPP were particularly important for uptake, and barriers in terms of the referral process and health care professionals' engagement were reported. Specific digital features including health coaches and monitoring tools were important for engagement. CONCLUSIONS This study adds to the literature on factors that influence the uptake of and engagement with digital-DPPs and suggests that digital-DPPs can overcome many barriers to the uptake of face-to-face diabetes prevention programs in supporting lifestyle changes aimed at diabetes prevention.
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Affiliation(s)
- Jamie Ross
- Centre for Primary Care, Wolfson Institute of Population Health Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sarah Cotterill
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Elizabeth Murray
- E-health Unit, Department of Primary Care and Population Health, University College London, London, United Kingdom
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Al-Abbasi FA, Kazmi I. Therapeutic role of kaempferol and myricetin in streptozotocin-induced diabetes synergistically via modulation in pancreatic amylase, glycogen storage and insulin secretion. Mol Cell Biochem 2022:10.1007/s11010-022-04629-4. [PMID: 36583792 DOI: 10.1007/s11010-022-04629-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022]
Abstract
Kaempferol and Myricetin alone have promising benefits on diabetes and related complications, yet the effectiveness of cotreating the two compounds on diabetes have not been studied. The existing investigation was to study the combined anti-diabetic effect of kaempferol and myricetin in Streptozotocin (STZ)-activated diabetes in rats. To evaluate the anti-diabetic activity, 36 Wistar rats were segregated into six groups; Normal, 50 mg/kg STZ-induced diabetes, and four (50 mg/kg kaempferol, 50 mg/kg myricetin, 25 mg/kg kaempferol + myricetin, and 5 mg/kg glibenclamide) compound-treated diabetic groups. The effects of co-treatment on parameters, glucose, insulin, lipid profile, liver enzymes, antioxidant biomarkers, and inflammatory cytokines were measured. The study revealed that combined treatment restored the assessed parameters including glucose levels, inflammatory cytokines, oxidative markers, and lipid and liver enzymes in diabetic rats. The results indicate that cotreatment of kaempferol and myricetin has a beneficial role against diabetes suggesting that cotreatment of these compounds can be used therapeutically in treating diabetes.
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Affiliation(s)
- Fahad A Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabet Med 2022; 39:e14748. [PMID: 34806793 DOI: 10.1111/dme.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. METHODS An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. RESULTS Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. CONCLUSIONS How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.
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Affiliation(s)
- Kirstine Schmidt
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Faerch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Annemarie R Varming
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Coppell KJ, Abel S, Whitehead LC, Tangiora A, Spedding T, Tipene-Leach D. A diagnosis of prediabetes when combined with lifestyle advice and support is considered helpful rather than a negative label by a demographically diverse group: A qualitative study. Prim Care Diabetes 2022; 16:301-306. [PMID: 34953750 DOI: 10.1016/j.pcd.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS The aim of this study was to explore the experience and perceptions of a diagnosis of prediabetes among a demographically diverse sample of New Zealanders who had, and had not, regressed to normoglycaemia following participation in a primary care nurse-delivered intervention for 6 months. The sample included Indigenous Māori who have high rates of diabetes and associated co-morbidities. METHODS A purposefully selected sample of 58 people with prediabetes and BMI >25 kg/m2, stratified by male/female, Māori/non-Māori, and those who had/had not regressed to normoglycaemia, after completing 6-months of a prediabetes intervention were interviewed. Interviews were audio-recorded and transcribed. Data were analysed by thematic analysis. RESULTS Most participants recalled being shocked when told they had prediabetes, but they did not perceive the diagnosis to be a label in a negative sense, and some, described the diagnosis as helpful. Participants appreciated knowing that prediabetes could be reversed, and the opportunity to be able to take supported action and make lifestyle changes through the nurse-delivered prediabetes lifestyle intervention. Participants' clear preference was to take control and make dietary changes, not to take Metformin. CONCLUSIONS Prediabetes was not considered a negative label, but an opportunity, when coupled with a primary care nurse-delivered dietary intervention.
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Affiliation(s)
- Kirsten J Coppell
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Sally Abel
- Kaupapa Consulting Ltd., 52 Vigor Brown St, Napier 4110, New Zealand
| | - Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia
| | | | - Terrie Spedding
- Health Hawke's Bay, 100 McLeod Street, Hastings 4120, New Zealand
| | - David Tipene-Leach
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier 4112, Hawke's Bay, New Zealand
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Yoon S, Wee S, Loh DHF, Bee YM, Thumboo J. Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes. Front Endocrinol (Lausanne) 2022; 13:816385. [PMID: 35295990 PMCID: PMC8919042 DOI: 10.3389/fendo.2022.816385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to identify facilitators and barriers to the uptake of a community-based diabetes prevention program (DPP) from the perspectives of decliners with prediabetes in a multi-ethnic Asian community. METHODS Semi-structured interviews were conducted with 29 individuals with prediabetes who declined participation in a large community-based diabetes prevention program in Singapore. Thematic analysis was undertaken to identify themes, which were subsequently mapped onto the Capacity-Opportunity-Motivation and Behavior model (COM-B). RESULTS We identified 16 key themes under three COM-B domains. Health status at the time of invitation, perceived ability of self-management, understanding of prediabetes condition and/or the program intention (Capability) were important determinants. Family commitment had the strong potential to enable or hinder physical and social Opportunity related to participation. Many participants desired involvement of physician as part of program invitation and component. Fear of exacerbation coupled with an automatic aversion for suffering influenced Motivation for participation. CONCLUSION Identifying facilitators and barriers embedded in the COM-B will assist systematic program modifications to increase participation of individuals with prediabetes. How information about modifiable risk factors is communicated by physicians at the point of diagnosis and program introduction is key to participation. Co-locating programs with family activity, development of mHealth, readiness assessment, and tailored explanation of program purpose may increase participation. These findings will be used to guide future national interventions in the community to ensure successful implementation.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- *Correspondence: Sungwon Yoon,
| | - Sharon Wee
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Dionne H. F. Loh
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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Ledford CJW, Seehusen DA, Cafferty LA, Rider HA, Rogers T, Fulleborn S, Clauson E, Ledford CC, Trigg S, Jackson JT, Crawford PF. Diabetes ROADMAP: Teaching Guideline Use, Communication, and Documentation When Delivering the Diagnosis of Diabetes. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10959. [PMID: 32934981 PMCID: PMC7485911 DOI: 10.15766/mep_2374-8265.10959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/25/2020] [Indexed: 06/11/2023]
Abstract
Introduction Most interventions to date regarding breaking bad news focus on late-stage disease or disclosing a cancer diagnosis. Little attention has been given to delivery of chronic metabolic disease diagnoses such as prediabetes/type 2 diabetes. Methods Informed by the American Diabetes Association standards of care and formative research conducted by our research team, we developed this curriculum through the six-step approach to curriculum development. The curriculum consists of a 2- or 3-hour intervention that teaches medical decision-making, interpersonal communication, and clinical documentation in the context of prediabetes and type 2 diabetes followed by role-play and clinical practice. Results Across three cohorts, 53 clinicians completed the curriculum. Across the three iterations, learners rated the curricular intervention as worthwhile and delivered at an appropriate level. In a community hospital setting, learners scored significantly higher on a knowledge check than did a control group of six clinicians (p < .001). Learners in the community hospital also indicated high response efficacy and self-efficacy. At the academic medical center, simulated patients indicated high measures on the Diabetes Health Threat Communication Questionnaire. Discussion The moment of diagnosis presents a key opportunity to affect patients' perceptions of the disease. This curriculum guides clinicians in making the most of diagnosis delivery. Pairing of qualitative, patient-centered research alongside the iterative curriculum design process allows the curriculum to be adaptable and scalable to multiple settings and learner types.
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Affiliation(s)
- Christy J. W. Ledford
- Associate Professor, Family Medicine, Uniformed Services University of the Health Sciences
| | - Dean A. Seehusen
- Associate Dean for Graduate Medical Education and Professor of Family Medicine, Augusta University
| | - Lauren A. Cafferty
- Clinical Research Coordinator, Military Primary Care Research Network, Department of Family Medicine, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation
| | - Heather A. Rider
- Research Coordinator, Clinical Investigations Program, Mike O'Callaghan Military Medical Center
| | - Tyler Rogers
- Leader and Faculty Development Fellow, Madigan Army Medical Center
| | - Stephanie Fulleborn
- Resident Physician, Family Medicine, Eglin Air Force Base Family Medicine Residency
| | - Erik Clauson
- Staff Physician, Family Medicine, Eglin Air Force Base Family Medicine Residency
| | | | - Steven Trigg
- Resident Physician, Family Medicine, Eglin Air Force Base Family Medicine Residency
| | - Jeremy T. Jackson
- Publications Coordinator, Military Primary Care Research Network, Department of Family Medicine, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation
| | - Paul F. Crawford
- Professor of Family Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, and Nellis Air Force Base Family Medicine Residency
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Ledford CJW, Seehusen DA, Crawford PF. The relationship between patient perceptions of diabetes and glycemic control: A study of patients living with prediabetes or type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2019; 102:2097-2101. [PMID: 31176557 DOI: 10.1016/j.pec.2019.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/03/2019] [Accepted: 05/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aims to identify differences in how patients living with prediabetes (preDM) or type 2 diabetes (T2DM) perceive their illness. METHODS Following chart review, a cross-sectional survey was administered to patients diagnosed with preDM or T2DM at two US medical centers. RESULTS Among 757 respondents, multivariate tests demonstrate that patients living with T2DM have an overall different personal model of disease than patients living with preDM. Patients who have been diagnosed with T2DM report a better understanding of their disease and perceive it to be more chronic in nature than patients living with preDM. Findings revealed a potential but less significant difference in perceived seriousness. CONCLUSIONS In this first application of personal models of disease to prediabetes, results inform implications for clinicians to talk with patients about preDM. Patients living with preDM indicate less understanding of the "disease" and perceive it to be less "chronic," which may result from unclear clinician communication about preDM. PRACTICE IMPLICATIONS When clinicians talk to patients about prediabetes, they should present the risk factor within the spectrum of glucose tolerance. Although labeled a risk factor, clinicians should emphasize that prediabetes remains a serious concern that will not lessen without intervention.
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Affiliation(s)
- Christy J W Ledford
- Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA.
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