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Turner CD, Thomas TW, Sedgwick T, Yassin M, Stoll SC, Lindsay R, Heisler M, Schmittdiel JA. Dyadic concordance and other considerations for matching pairs for peer support diabetes prevention interventions: A mixed methods assessment. PATIENT EDUCATION AND COUNSELING 2024; 129:108407. [PMID: 39190987 DOI: 10.1016/j.pec.2024.108407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/02/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES Dyadic peer support helps patients make health behavior changes for improved outcomes, yet the impact of matching dyads on demographic characteristics such as race or gender is unknown. Therefore, we investigated associations of concordant characteristics with peer outcomes in a diabetes prevention intervention and qualitatively examined participant perspectives on matching. METHODS Binary variables for peer-supporter concordance on 6 demographic characteristics were created for 177 peers and 69 supporters. Regression models compared changes in weight, HbA1c, perceived social support, patient activation, and formal diabetes prevention/education program participation for concordant and non-concordant dyads. Semi-structured qualitative interviews were conducted with 39 peers and 34 supporters. RESULTS Concordance on demographic characteristics was not significantly associated with outcomes. Qualitatively, peers and supporters emphasized that more important than shared demographic characteristics was a supporter's empathic, non-judgmental communication style. CONCLUSIONS Demographic characteristics for matching supporters with adults with prediabetes are less important than ensuring high-quality coach training in goal setting and communication style, supporting prior research on the necessity of autonomy supportive communication for effective behavioral change interventions. PRACTICE IMPLICATIONS Existing peer support programs should incorporate fidelity assessments into practice to ensure peer supporter skill in motivational interviewing-based, autonomy supportive communication and brief goal setting.
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Affiliation(s)
- Cassie D Turner
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, USA.
| | - Tainayah W Thomas
- Division of Research, Kaiser Permanente Northern California, Oakland, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Tali Sedgwick
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Maher Yassin
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Shelley C Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA
| | - Rebecca Lindsay
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA; Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, USA; Department of Health System Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA
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Virtič Potočnik T, Mihevc M, Zavrnik Č, Mori Lukančič M, Ružić Gorenjec N, Poplas Susič A, Klemenc-Ketiš Z. Evaluation of a specialist nurse-led structured self-management training for peer supporters with type 2 diabetes mellitus with or without comorbid hypertension in Slovenia. BMC Nurs 2024; 23:567. [PMID: 39148069 PMCID: PMC11328385 DOI: 10.1186/s12912-024-02239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/07/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND The training of peer supporters is critical because the success of the entire peer support intervention depends on the knowledge and experience that peer supporters can share with other patients. The objective of this study was to evaluate the pilot implementation of a specialist nurse-led self-management training programme for peer supporters with type 2 diabetes mellitus (T2DM) with or without comorbid hypertension (HTN) at the primary healthcare level in Slovenia, in terms of feasibility, acceptability, and effectiveness. METHODS A prospective pre-post interventional pilot study was conducted in two Community Health Centres (CHC) in Slovenia from May 2021 to August 2022. Purposive sampling was employed to recruit approximately 40 eligible volunteers to become trained peer supporters. A specialist nurse-led structured training lasting 15 h over a 2-month period was delivered, comprising four group and two individual sessions. The comprehensive curriculum was based on interactive verbal and visual learning experience, utilising the Diabetes Conversation Maps™. Data were collected from medical records, by clinical measurements, and using questionnaires on sociodemographic and clinical data, the Theoretical Framework of Acceptability, knowledge of T2DM and HTN, and the Appraisal of Diabetes Scale, and evaluation forms. RESULTS Of the 36 participants, 31 became trained peer supporters (retention rate of 86.1%). Among them, 21 (67.7%) were women, with a mean age of 63.9 years (SD 8.9). The training was evaluated as satisfactory and highly acceptable. There was a significant improvement in knowledge of T2DM (p < 0.001) and HTN (p = 0.024) among peer supporters compared to baseline. Six months post-training, there was no significant improvement in the quality of life (p = 0.066), but there was a significant decrease in body mass index (BMI) (p = 0.020) from 30.4 (SD 6.2) at baseline to 29.8 (SD 6.2). CONCLUSION The pilot implementation of a specialist nurse-led self-management training for peer supporters was found to be feasible, acceptable, and effective (in the study group). It led to improvements in knowledge, maintained disease control, and promoted positive self-management behaviours among peer supporters, as evidenced by a decrease in their BMI over six months. The study emphasises the need for effective recruitment, training, and retention strategies. TRIAL REGISTRATION The research is part of the international research project SCUBY: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium, which is registered in ISRCTN registry ( https://www.isrctn.com/ISRCTN41932064 ).
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Affiliation(s)
- Tina Virtič Potočnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, Department of Family Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia.
| | - Matic Mihevc
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
- Faculty of Medicine, Department of Family Medicine, University of Ljubljana, Poljanski Nasip 58, 1000, Ljubljana, Slovenia
| | - Črt Zavrnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
- Faculty of Medicine, Department of Family Medicine, University of Ljubljana, Poljanski Nasip 58, 1000, Ljubljana, Slovenia
| | - Majda Mori Lukančič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
- Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Antonija Poplas Susič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
- Faculty of Medicine, Department of Family Medicine, University of Ljubljana, Poljanski Nasip 58, 1000, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia
- Faculty of Medicine, Department of Family Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia
- Faculty of Medicine, Department of Family Medicine, University of Ljubljana, Poljanski Nasip 58, 1000, Ljubljana, Slovenia
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Tang TS, Yip AKW, Klein G, Moore L, Hessler D, Polonsky WH, Fisher L. Training peers to deliver mental health support to adults with type 1 diabetes using the REACHOUT mobile app. Diabet Med 2024; 41:e15210. [PMID: 37634222 DOI: 10.1111/dme.15210] [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: 04/13/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
AIMS While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST. METHODS Fifty-three adults with T1D were recruited to participate in a 6-hour, zoom-based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre-established competency criteria during a 5-day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention. RESULTS Fifty-one of the fifty-three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open-ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful. CONCLUSIONS Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie K W Yip
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerri Klein
- BCDiabetes, Vancouver, British Columbia, Canada
| | - Lauren Moore
- Lauren Moore Counseling, British Columbia, Canada
| | - Danielle Hessler
- Department of Family Medicine, University of California, San Francisco, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, USA
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Botchway M, Davis RE, Merchant AT, Appiah LT, Sarfo-Kantanka O, Moore S. Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana. ETHNICITY & HEALTH 2023; 28:281-298. [PMID: 35098827 DOI: 10.1080/13557858.2022.2033172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.
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Affiliation(s)
- Marian Botchway
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lambert T Appiah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Spencer Moore
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Health & Society Group, Wageningen University & Research, Wageningen, Netherlands
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Weitgasser R, Ciardi C, Traub J, Barta M, Riedl M, Clodi M, Ludvik B. [Diabetes education and counseling in adult patients with diabetes (Update 2023)]. Wien Klin Wochenschr 2023; 135:137-142. [PMID: 37101034 PMCID: PMC10133358 DOI: 10.1007/s00508-022-02120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
Diabetes education and self-management play a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and subsequent treatment modification as well as the ability of patients to integrate diabetes into their daily life and to appropriately adapt diabetes to their life style situation. Diabetes education has to be made accessible for all persons with the disease. In order to be able to provide a structured and validated education program, adequate personnel as well as space, organizational and financial prerequisites are required. Besides an increase in knowledge about the disease it has been shown that a structured diabetes education is able to improve diabetes outcome as measured by parameters, such as blood glucose, HbA1c, lipids, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes into everyday life, stress physical activity besides healthy eating as important components of life style therapy and use interactive methods in order to increase the acceptance of personal responsibility. Specific situations (e.g. impaired hypoglycemia awareness, illness, travel), the occurrence of diabetic complications and the use of technical devices such as glucose sensor systems and insulin pumps require additional educational measures supported by adequate electronic tools (diabetes apps and diabetes web portals). New data demonstrate the effect of telemedicine and internet-based services for diabetes prevention and management.
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Affiliation(s)
- Raimund Weitgasser
- Kompetenzzentrum Diabetes, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Julia Traub
- Ernährungsmedizinischer Dienst, LKH Univ. Klinik Graz, Graz, Österreich
| | - Merlena Barta
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Michaela Riedl
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Martin Clodi
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
- Abteilung für Innere Abteilung, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich.
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
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Lu S, Leduc N, Moullec G. Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3267-3278. [PMID: 36038395 DOI: 10.1016/j.pec.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
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Affiliation(s)
- Sonia Lu
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada.
| | - Nicole Leduc
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, Montreal, Canada
| | - Grégory Moullec
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada
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Majjouti K, Küppers L, Thielmann A, Redaélli M, Vitinius F, Funke C, van der Arend I, Pilic L, Hessbrügge M, Stock S, Weltermann B, Wild D. Family doctors’ attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners. BMC PRIMARY CARE 2022; 23:220. [PMID: 36045339 PMCID: PMC9427433 DOI: 10.1186/s12875-022-01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
Background Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. Methods In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs‘role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. Results A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs’ who expected long-term benefits for their workload was relatively low (37.6%). Conclusions In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01827-3.
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Li Y, Storch EA, Ferguson S, Li L, Buys N, Sun J. The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2022; 189:109965. [PMID: 35718018 DOI: 10.1016/j.diabres.2022.109965] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes. METHODS Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality. RESULTS 32 RCTs were included. Results revealed that CBT could reduce HbA1c: -0.14% (95% CI: -0.25 to -0.02%, P = 0.020); FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040); DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001); depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001); anxiety symptoms: -0.28 (95% CI: -0.50 to -0.07, P = 0.009); improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies. CONCLUSION CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Samantha Ferguson
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province 315010, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia.
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Duan B, Liu Z, Liu W, Gou B. Views and needs of people who at high-risk of gestational diabetes mellitus for the development of mobile health applications: A descriptive qualitative research (Preprint). JMIR Form Res 2022; 6:e36392. [PMID: 35802414 PMCID: PMC9308070 DOI: 10.2196/36392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications.
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Affiliation(s)
- Beibei Duan
- School of Nursing, Capital Medical University, Beijing, China
| | - Zhe Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Baohua Gou
- Beijing Youyi Hospital, Capital Medical University, Beijing, China
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Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, Rea D, Rayman G, Dhatariya K, John WG, Barton G, Usher R, Ferns C, Pascale M. Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial. BMC Med 2021; 19:183. [PMID: 34407811 PMCID: PMC8375190 DOI: 10.1186/s12916-021-02053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes. METHODS We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months. RESULTS We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants < 65 years old (difference in mean HbA1c compared to CON -4.76 mmol/mol; 95% CI -7.75, -1.78 mmol/mol) than in older participants (-0.46 mmol/mol; 95% CI -2.67, 1.75; interaction p = 0.02). This effect was most significant in the INT-DPM arm (-6.01 mmol/mol; 95% CI -9.56, -2.46 age < 65 years old and -0.22 mmol/mol; 95% CI -2.7, 2.25; aged > 65 years old; p = 0.007). The use of oral hypoglycaemic medication was associated with a significantly lower mean HbA1c but only within the INT-DPM arm compared to CON (-7.0 mmol/mol; 95% CI -11.5, -2.5; p = 0.003). CONCLUSION The NDPS lifestyle intervention significantly improved glycaemic control after 12 months in people with screen-detected type 2 diabetes when supported by trained peer mentors with type 2 diabetes, particularly those receiving oral hypoglycaemics and those under 65 years old. The effect size was modest, however, and not sustained at 24 months. TRIAL REGISTRATION ISRCTN34805606 . Retrospectively registered 14.4.16.
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Affiliation(s)
- Michael Sampson
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nikki Garner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Jane Smith
- University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, UK
| | - Jeremy Turner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Dave Rea
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Gerry Rayman
- Department of Diabetes and Endocrinology, Ipswich General Hospital NHS Trust, Ipswich, UK
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - W Garry John
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department Clinical Biochemistry, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rebecca Usher
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Clare Ferns
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
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Handley MA, Landeros J, Wu C, Najmabadi A, Vargas D, Athavale P. What matters when exploring fidelity when using health IT to reduce disparities? BMC Med Inform Decis Mak 2021; 21:119. [PMID: 33827562 PMCID: PMC8028253 DOI: 10.1186/s12911-021-01476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Implementation of evidence-based interventions often involves strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with 'on-the ground' tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations. METHODS We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study's purpose was to explore fidelity to pre-determined 'core' (e.g. systems integration) and 'modifiable' equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included. RESULTS 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n = 81) completed ≥ one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n = 152) of the English call triggers and for 80.0% (n = 279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n = 85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p = < 0.01) and English-speakers reporting health coaches were less considerate of their time (p = 0.03). CONCLUSIONS By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability. Trial Registration National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA.
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA.
| | - Jerad Landeros
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Cindie Wu
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Adriana Najmabadi
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Daniela Vargas
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Priyanka Athavale
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
- University of California, Berkeley School of Public Health, Berkeley, USA
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