Assessing psychosocial variables: a tool for diabetes educators

The OnTrack Diabetes Web-Based Program for Type 2 Diabetes and Dysphoria Self-Management: A Randomized Controlled Trial Protocol

Background

The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location

Objective

This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients.

Methods

A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted.

Results

This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia.

Conclusions

This is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.

Trial Registration

Australian and New Zealand Clinical Trials Registration number: ACTRN12612000620820; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000620820 (Archived by WebCite at http://www.webcitation.org/6a3BeXC5m).

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points.

Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression

Purpose:

The purpose of this study was to implement a continuous quality improvement project aimed at improving primary care provider recognition of depression.

Materials and Methods:

A randomized, blinded, pre- and post-test design was implemented with 92 adults attending an academic internal medicine clinic. Subjects were assigned to an intervention where healthcare technicians (HCT) trained in the fundamentals of diabetes education delivered brief probing questions about self-care behavior and tailored talking points to encourage patients to talk to their primary care physician about their emotional health. The control group received a sham intervention that included only information on standards of diabetes care. Measures included both a paper-and-pencil screening of depression and the Primary Healthcare Questionnaire-8 (PHQ-8). Outcomes were evaluated for antidepressant and/or counseling treatment modalities once the possibility of depression was identified.

Results:

Both the control and intervention groups improved from pre-test to 3-month post-test scores on the PHQ-8 in clinically significant ways, but continued to have moderate to severe depression symptoms. There was a significant likelihood of receiving antidepressant therapy and/or counseling in those who scored high on the PHQ-8.

Conclusion:

HCT can be trained to talk to patients about emotional health issues during routine primary care visits. Depression screening measures can be administered as part of the triage routine at the start of a primary care visit, along with tasks such as vital signs. Answering a screening measure can help create awareness of symptoms and feelings that can prompt discussion during the patient–provider encounter that can result in the diagnosis and treatment of depression.

Strategic management of behavioural change in type 2 diabetic patients

OBJECTIVES

To investigate the key factors in and gap between perception and performance of daily blood glucose monitoring, regular exercise and diet control in individuals with type 2 diabetes, and to help develop patient-centric healthcare management strategies.

STUDY DESIGN

Cross-sectional study.

METHODS

A focus group interview was conducted and questionnaires were collected from outpatients with type 2 diabetes. Paired sample t-tests, importance-performance gap analysis and regression analysis were performed.

RESULTS

Perseverance was the key factor affecting blood glucose monitoring and regular exercise; the association was stronger in men than women. The critical factor in diet control was the desire to eat. Patients' perceived severity of diabetes and limited daily activities due to diabetes correlated with regular exercise, patients' compliance correlated with glucose monitoring, and perceived health status correlated with diet control.

CONCLUSIONS

The cultivation of perseverance and strengthening psychological coping is critical. Health professionals should design tailored services, avoid didactic intervention education programmes, and develop a 'meaning-centred' rather than a 'message-centred' philosophy of exercise. Such a campaign may help to improve self-management and promote health behaviours for people with type 2 diabetes.

Motives for regular physical activity in women and men: a qualitative study in French adults with type 2 diabetes, belonging to a patients' association

Patients' associations are an integral but often overlooked component of the French healthcare system dominated by the medical profession. Very few patients' associations exist to enable patients to self-manage into physical activity programmes. The aim of this qualitative study was to examine perceived motives for regular physical activity in male and female individuals, with type 2 diabetes involved in one French patients' association, called 'Move for Health'. Twenty-three adults (14 women and 9 men) with type 2 diabetes ranging in age from 35 to 78 volunteered to participate. The participants undertook regular physical activities autonomously with some medico-sporting educators' help. Results showed that participants reported intrinsic motives such as enjoyment, interest, fun, stimulation and highlighted gender differences. Female participants were more likely than male participants to emphasise the importance of emotional support obtained from the group meetings, and the pleasure of doing something together, and male participants emphasised the knowledge acquisition and skill development for disease control. Moreover, female participants indicated the importance of the sense of well-being and the positive body image related to regular physical activity, and male participants underlined the strength of the relationship between physical activity and health-promoting behaviours. This study provides insights into how gender motives are related to the interest and usefulness of physical activities in the management of diabetes. Findings lend support to the setting up of this type of patients' association in the French healthcare system and underline its contribution to self-determination and the behaviour change process in people with diabetes.