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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [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: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
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.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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2
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Moghadam S, Hollands L, Calitri R, Swancutt D, Lloyd J, Hawkins L, Sheaff R, Dean S, Perry S, Watkins R, Pinkney J, Tarrant M. Development of a group-based behaviour change intervention for people with severe obesity informed by the social identity approach to health. Br J Health Psychol 2024. [PMID: 38965643 DOI: 10.1111/bjhp.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/23/2024] [Accepted: 06/09/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. METHODS A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. RESULTS A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. CONCLUSIONS A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.
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Cheung WC, Miles LM, Hawkes RE, French DP. Experiences of online group support for engaging and supporting participants in the National Health Service Digital Diabetes Prevention Programme: A qualitative interview study. J Health Serv Res Policy 2024; 29:100-110. [PMID: 38096783 PMCID: PMC10910750 DOI: 10.1177/13558196231212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The National Health Service Digital Diabetes Prevention Programme is a nine-month behavioural intervention for adults in England at risk of type 2 diabetes. This qualitative study aimed to explore how service users engaged with the group support available within the programme. METHODS The majority of participants (n = 33), all service users, were interviewed twice via telephone, at 2-4 months into the programme, and at the end of the programme at 8-10 months. Semi-structured interviews covered participants' experiences of online group support functions and how such groups served as a route of support to aid participants' behavioural changes. Data were analysed using manifest thematic analysis. RESULTS The majority of participants valued the format of closed group chats, which provided an interactive platform to offer and receive support during their behaviour change journey. However, engagement with group chats reduced over time, and some participants did not find them useful when there was a lack of common interests within the group. Health coaches helped to promote engagement and build rapport among participants within the group chats. Participants reported mixed experiences of discussion forums. CONCLUSIONS Programme developers should consider how to optimise online group support to help service users make behavioural changes, in terms of format, participant composition and use of health coach moderators. Further research is required to better understand who might benefit most from 'group chat' or 'discussion forum' support. Health coach moderation of online support groups is likely to facilitate engagement.
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Affiliation(s)
- Wang Chun Cheung
- Research Assistant, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa M Miles
- Research Associate, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rhiannon E Hawkes
- Research Associate, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P French
- Professor of Health Psychology, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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4
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Guldemond N. What is meant by 'integrated personalized diabetes management': A view into the future and what success should look like. Diabetes Obes Metab 2024; 26 Suppl 1:14-29. [PMID: 38328815 DOI: 10.1111/dom.15476] [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: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Integrated personalized diabetes management (IPDM) has emerged as a promising approach to improving outcomes in patients with diabetes mellitus (DM). This care approach emphasizes the integration and coordination of different providers, including physicians, nurses, dietitians, social workers and pharmacists. The goal of IPDM is to provide patients with personalized care that is tailored to their needs. This review addresses the concept of integrated care and the use of technology (including data, software applications and artificial intelligence) as well as managerial, regulatory and financial aspects. The implementation and upscaling of digitally enabled IPDM are discussed, with elaboration of successful practices and related evidence. Finally, recommendations are made. It is concluded that the adoption of digitally enabled IPDM on a global level is inevitable, considering the challenges created by an increasing prevalence of patients with DM and the need for better outcomes and improvement of health system sustainability.
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Affiliation(s)
- Nick Guldemond
- Department of Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, Netherlands
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5
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Nichols VP, Abraham C, Eldabe S, Sandhu HK, Underwood M, Seers K. 'It was a joint plan we worked out together'. How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids: a process evaluation. BMJ Open 2023; 13:e074603. [PMID: 38056940 PMCID: PMC10711817 DOI: 10.1136/bmjopen-2023-074603] [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: 04/20/2023] [Accepted: 10/18/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial found that a group-based educational intervention to support people using strong opioids for chronic non-malignant pain helped a significant proportion of people to stop or decrease opioid use with no increase in pain-related disability. We report a linked process evaluation of the group-based intervention evaluated in comparison to a usual-care control group that received a self-help booklet and relaxation CD. METHODS We interviewed 18 intervention facilitators, and 20 intervention and 20 control participants who had chronic non-malignant pain and were recruited from general (family) practices in the UK. Quantitative data included change mechanism questions on the trial questionnaires which explored motivation, expectations and self-efficacy. Fidelity was assessed by listening to a sample of audio-recorded group sessions and nurse consultations. Quantitative and qualitative data were integrated using 'follow a thread' and a mixed-methods matrix. FINDINGS Four overarching themes emerged: (1) the right time to taper, (2) the backdrop of a life with chronic pain, (3) needing support and (4) the benefits of being in a group. Delivery fidelity was good, adherence (83%) and competence (79%) across a range of intervention groups. Staff delivering the intervention found three typical responses to the intervention: resistance, open to trying and feeling it was not the right time. The group experience was important to those in the intervention arm. It provided people with a forum in which to learn about the current thinking about opioid usage and its effects. It also gave them examples of how feasible or personally relevant coming off opioids might be. CONCLUSION The process evaluation data showed that the I-WOTCH intervention was well delivered, well received and useful for most interviewees. Being 'the right time' to taper and having support throughout tapering, emerged as important factors within the context of living with chronic pain. TRIAL REGISTRATION NUMBER ISRCTN49470934.
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Affiliation(s)
- Vivien P Nichols
- Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | - Charles Abraham
- School of Psychology, Burwood Campus, Deakin University, Melbourne, New South Wales, Australia
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | | | - Martin Underwood
- Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | - Kate Seers
- Warwick Medical School, Warwick University, Coventry, UK
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Miller NA, Ehmann MM, Hagerman CJ, Forman EM, Arigo D, Spring B, LaFata EM, Zhang F, Milliron BJ, Butryn ML. Sharing digital self-monitoring data with others to enhance long-term weight loss: A randomized controlled trial. Contemp Clin Trials 2023; 129:107201. [PMID: 37080355 PMCID: PMC10231946 DOI: 10.1016/j.cct.2023.107201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Participants in behavioral weight loss (BWL) programs increasingly use digital tools to self-monitor weight, physical activity, and dietary intake. Data collected with these tools can be systematically shared with other parties in ways that might support behavior change. METHODS Adults age 18 to 70 with overweight/obesity (BMI 27-50 kg/m2) will enroll in a remotely delivered, 24-month BWL program designed to produce and maintain a 10% weight loss. Participants will be asked to use a wireless body weight scale, wearable activity sensor, and dietary intake app daily. All participants will receive individual and group counseling, engage in text messaging with members of their group, and appoint a friend or family member to serve in a support role. A 2x2x2 factorial design will test the effects of three types of data sharing partnerships: 1) Coach Share: The behavioral coach will regularly view digital self-monitoring data and address data observations. 2) Group Share: Participants will view each other's self-monitoring data in small-group text messages. 3) Friend/Family Share: A friend or family member will view the participant's data via automated message. The primary outcome is weight loss at 24 months. Mediators and moderators of intervention effects will be tested. CONCLUSION This study will provide a clear indication of whether data sharing can improve long-term weight loss. This study will be the first to discern the mechanisms of action through which each type of data sharing may be beneficial, and elucidate conditions under which the benefits of data sharing may be maximized.
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Affiliation(s)
- Nicole A Miller
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
| | - Marny M Ehmann
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Charlotte J Hagerman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Danielle Arigo
- Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall, Glassboro, NJ 08028, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University, 60 N 36th St, 11(th) floor, Philadelphia, PA 19104, United States
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States; Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street Stratton Hall, Philadelphia, PA 19104, United States.
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Leviton A, Patel AD, Loddenkemper T. Self-management education for children with epilepsy and their caregivers. A scoping review. Epilepsy Behav 2023; 144:109232. [PMID: 37196451 DOI: 10.1016/j.yebeh.2023.109232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA.
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Shakya P, Bajracharya M, Skovlund E, Shrestha A, Karmacharya BM, Kulseng BE, Sen A, Steinsbekk A, Shrestha A. How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5054. [PMID: 36981962 PMCID: PMC10048900 DOI: 10.3390/ijerph20065054] [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: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.
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Affiliation(s)
- Pushpanjali Shakya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Monish Bajracharya
- Department of Business and IT, University of South-Eastern Norway, 3800 Bø, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Bård Eirik Kulseng
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Centre for Oral Health Services and Research (TkMidt), 7030 Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
- Institute for Implementation Science and Health, Kathmandu 44600, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06520-0834, USA
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Bohn-Goldbaum E, Cashmore A, Bauman A, Sullivan A, Fonua LR, Milat A, Reid K, Grunseit A. Team characteristics associated with weight loss in a First Nations community intervention: An observational study. Health Promot J Austr 2023; 34:9-12. [PMID: 36089699 PMCID: PMC10092725 DOI: 10.1002/hpja.663] [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: 12/21/2021] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/30/2023] Open
Abstract
ISSUE ADDRESSED Group-based weight-loss programs can be effective in addressing high rates of overweight and obesity among Aboriginal and Torres Strait Islander Peoples. The purpose was to determine associations between demographic and baseline weight-related variables and team weight loss in a community-based intervention as no previous studies have analysed this at a team level. METHODS Binomial models tested associations between team-level age, proportion female and baseline weight and classification as higher weight-loss team (HWT) (>50% persons losing 2.5% of initial weight) vs lower weight-loss team (LWT). Linear regressions compared HWT and LWT on diet and physical activity (PA) outcomes adjusted for age and gender. RESULTS For each 1 kg increment in mean baseline weight, a team's likelihood of higher weight loss was increased by 4% (APR: 1.04, 95%CI: 1.00, 1.08). HWTs increased vigorous PA by 0.32 sessions more than LWTs (P = .02). Fruit and vegetable intakes were not associated with team weight loss classification. CONCLUSIONS Only baseline weight and vigorous PA distinguished HWT and LWT. Promoting PA components in team-based weight-loss approaches may be beneficial as these lend themselves to group participation. SO WHAT?: Demographic and baseline weight-related variables are largely not predictive of weight loss success in group programs. Identifying other characteristics shared by HWT may help teams achieve weight loss.
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Affiliation(s)
- Erika Bohn-Goldbaum
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Camperdown, New South Wales, Australia.,The Australian Partnership for Prevention Centre, Glebe, New South Wales, Australia
| | - Aaron Cashmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Camperdown, New South Wales, Australia.,The Australian Partnership for Prevention Centre, Glebe, New South Wales, Australia
| | - Anna Sullivan
- Population and Public Health Division, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Lose Rose Fonua
- Population and Public Health Division, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Andrew Milat
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Camperdown, New South Wales, Australia.,The Australian Partnership for Prevention Centre, Glebe, New South Wales, Australia.,Population and Public Health Division, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Kate Reid
- Population and Public Health Division, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Anne Grunseit
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Camperdown, New South Wales, Australia.,The Australian Partnership for Prevention Centre, Glebe, New South Wales, Australia
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Rigby RR, Mitchell LJ, Hamilton K, Ball L, Williams LT. Analyzing Dietary Behaviors Self-reported by People With Diabetes Using a Behavior Change Technique Taxonomy. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:753-763. [PMID: 35644787 DOI: 10.1016/j.jneb.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We aimed to explore both the dietary-related behavior change techniques (BCTs) adults with type 2 diabetes (T2D) described to enact themselves and the BCTs they perceived their dietitians to enact within consultations. DESIGN Qualitative study involving semistructured telephone interviews with adults who consulted with a dietitian after their T2D diagnosis. Participants shared their experience of dietary behavior change and interactions with dietitians. SETTING Telephone-based interviews from an Australian university setting. PARTICIPANTS Twenty-one adults (12 females and 9 males) aged 36-75 years were self-selected and invited by email. PHENOMENON OF INTEREST Dietary behavior changes reportedly enacted after a T2D diagnosis by participants and their dietitians. ANALYSIS Transcripts were analyzed through thematic content analysis according to the BCT taxonomy. RESULTS Participants described several BCTs such as problem-solving and self-monitoring (behavior), which helped their dietary behavior change. Participants perceived their dietitians to use BCTs, including goal setting (outcome), self-monitoring (behavior), and instruction on how to perform the behavior. These participants who had consulted with a dietitian reported additional techniques than those prescribed in the consultation process. CONCLUSIONS AND IMPLICATIONS Adults with T2D undertake a variety of BCTs to support dietary behavior change. Dietitians can draw on behavior change taxonomies to support behavior change in clients.
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Affiliation(s)
- Roshan R Rigby
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.
| | - Lana J Mitchell
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Kyra Hamilton
- Health and Psychology Innovations Research Lab, School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Lauren Ball
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
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11
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Nielsen SG, Danielsen JH, Grønbæk HN, Molsted S, Jacobsen SS, Vilsbøll T, Varming AR. Transforming Motivation for Exercise in a Safe and Kind Environment-A Qualitative Study of Experiences among Individuals with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106091. [PMID: 35627628 PMCID: PMC9141646 DOI: 10.3390/ijerph19106091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
Abstract
Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.
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Affiliation(s)
- Susanne Grøn Nielsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
- Correspondence:
| | - Julie Hagstrøm Danielsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Helle Nergaard Grønbæk
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Stig Molsted
- Department of Endocrinology, Nordsjællands Hospital, 3400 Hillerød, Denmark;
| | - Sandra Schade Jacobsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Annemarie Reinhardt Varming
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
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12
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Gordon C. Supporting the emotional well-being of patients with diabetes mellitus in primary care. Nurs Stand 2022; 37:77-82. [PMID: 35527714 DOI: 10.7748/ns.2022.e11863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
Diabetes mellitus is a condition characterised by elevated blood glucose levels that can lead to significant acute and long-term complications. Alongside these physical complications, the condition can have substantial effects on people's emotional well-being, potentially resulting in diabetes distress and/or major depressive disorder. Therefore, timely assessment and referral of patients with diabetes who display signs and symptoms of diabetes distress or other mental health conditions are essential. This article discusses emotional well-being in patients with diabetes, and outlines some diabetes-specific validated assessment tools that can be used in practice. It also discusses the management and appropriate onward referral of people with diabetes who require support.
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Affiliation(s)
- Charlotte Gordon
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle, England
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13
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Team members influence retention in a First Peoples’ community-based weight-loss program. Prev Med Rep 2022; 26:101710. [PMID: 35141119 PMCID: PMC8814646 DOI: 10.1016/j.pmedr.2022.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
Abstract
Program completion is strongly influenced by teammate completion. Other factors influencing program completion vary with participation occasion. Previous participation and health behaviors do not influence subsequent completion.
The aim of this study was to evaluate program retention factors in a repeated team-based weight-loss and healthy lifestyle program for Aboriginal and Torres Strait Islander Peoples. Data comprised 3107 participants in 10 Aboriginal Knockout Health Challenge contests. Multiple variable and bivariate analyses compared age, gender, self-reported behaviors (physical activity and fruit and vegetable consumption) and objectively measured weight between completers and non-completers. First-time participants (n = 3107) who completed were more likely to be female, be older, weigh less and have more completing members in their team; only the number of team members completing was significant among participants (n = 1245) who took part in a second contest participation. Multivariate results were similar, with a participant’s odds of completing on their first and second participation occasion increasing by 1.16 and 1.18, respectively, with every teammate completed. Given that the strongest effect centered on a social factor, this highlights the importance of having community-driven design and the benefits of a group-based approach to engage and maintain First Peoples’ engagement in preventive health programs. Further, by identifying a change in factors associated with retention in successive weight-loss attempts, this study improves understanding of retention in weight-loss programs more generally.
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14
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Miles LM, Hawkes RE, French DP. How is the Behavior Change Technique Content of the NHS Diabetes Prevention Program Understood by Participants? A Qualitative Study of Fidelity, With a Focus on Receipt. Ann Behav Med 2021; 56:749-759. [PMID: 34788358 PMCID: PMC9274983 DOI: 10.1093/abm/kaab093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The National Health Service (NHS) Diabetes Prevention Program (DPP) is a nationally implemented behavioral intervention for adults at high risk of developing Type 2 diabetes in England, based on a program specification that stipulates inclusion of 19 specific behavior change techniques (BCTs). Previous work has identified drift in fidelity from these NHS England specifications through providers’ program manuals, training, and delivery, especially in relation to BCTs targeting self-regulatory processes. Purpose This qualitative study investigates intervention receipt, i.e., how the self-regulatory BCT content of the NHS-DPP is understood by participants. Methods Twenty participants from eight NHS-DPP locations were interviewed; topics included participants’ understanding of self-monitoring of behavior, goal setting, feedback, problem solving, and action planning. Transcripts were analyzed thematically using the framework method. Results There was a wide variation in understanding among participants for some BCTs, as well as between BCTs. Participants described their understanding of “self-monitoring of behaviors” with ease and valued BCTs focused on outcomes (weight loss). Some participants learned how to set appropriate behavioral goals. Participants struggled to recall “action planning” or “problem solving” or found these techniques challenging to understand, unless additional support was provided (e.g., through group discussion). Conclusions Participants’ lack of understanding of some self-regulatory BCTs is consistent with the drift across fidelity domains previously identified from NHS design specifications. Behavioral interventions should build-in necessary support for participants to help them understand some BCTs such as action planning and problem solving. Alternatively, these self-regulatory BCTs may be intrinsically difficult to use for this population.
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Affiliation(s)
- Lisa M Miles
- Manchester Centre for Health Psychology, University of Manchester, Oxford Road, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, University of Manchester, Oxford Road, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Oxford Road, Manchester, UK
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15
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Zhao N, Luo X, Zhang H, Dai R, Pan W, Hambly BD, Bao S, Zhu X, Fan J. Cross-Sectional Study on Health Literacy and Internet Accessibility Among Patients With DM in Gansu, China. Front Public Health 2021; 9:692089. [PMID: 34722434 PMCID: PMC8548454 DOI: 10.3389/fpubh.2021.692089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the relationship between the health literacy of patients with diabetes mellitus (DM) and the accessibility of internet surfing for information concerning DM. Methods: A multistage stratified sampling method was utilized to conduct a questionnaire survey on DM health literacy and internet accessibility among 1,563 patients with DM in Gansu Province in 2020. Logistic regression was performed to analyze the factors that influence health literacy and internet accessibility; while the chi-square test was used to compare the differences in needs. Results: Among 1,563 valid questionnaires collected with an effective rate of 95.7%, there were 65.4, 66.3, or 51.1% of patients with DM were found to have good health knowledge, attitudes, or practice levels, respectively. Occupation, income, disease course of DM, and accessibility to the internet were the main factors influencing health literacy. Age, residency, occupation, education, income, and family history of DM were the factors influencing accessibility to internet surfing for DM. The expectations from patients with DM for the capacity to obtain DM information from traditional sources or through internet sources was 1,465 (93.7%) or 1,145 (73.3%), respectively. Patients with DM had a 2-fold higher desire to obtain DM health information from internet media if the patients had access to the internet than those without (P < 0.05). Conclusions: The socioeconomic status and access to the internet were the main contributing factors for health literacy, as socioeconomic status is closely related to access to the internet.
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Affiliation(s)
- Na Zhao
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China.,Hospital Infection-Control Department, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Xifeng Luo
- Department of Public Health, Pingliang Second People's Hospital, Pingliang, China
| | - Hailiang Zhang
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Runjing Dai
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Weimin Pan
- Department of Mental Health, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Brett D Hambly
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China.,Center for Health Futures, Torrens University Australia, Sydney, NSW, Australia
| | - Shisan Bao
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xiangdong Zhu
- School of Traditional Chinese Medicine, Ningxia Medical University, Yinchuan, China.,Basic Medical School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jingchun Fan
- Centre for Evidence-Based Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
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16
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Daley AJ, Jolly K, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Bensoussane H, Pritchett RV, Frew E, Parretti HM. Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT. Health Technol Assess 2021; 25:1-130. [PMID: 34382932 DOI: 10.3310/hta25490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING The trial took place in Birmingham, UK. PARTICIPANTS Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS Fewer participants were recruited than planned. CONCLUSIONS Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN12209332. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Hannah Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen M Parretti
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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