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Papoutsi C, Hargreaves D, Hagell A, Hounsome N, Skirrow H, Muralidhara K, Colligan G, Ferrey A, Vijayaraghavan S, Greenhalgh T, Finer S. Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings. BMC Med 2022; 20:459. [PMID: 36434593 PMCID: PMC9701006 DOI: 10.1186/s12916-022-02654-0] [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: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings. METHODS This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. RESULTS Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. CONCLUSIONS Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision. TRIAL REGISTRATION ISRCTN reference 27989430.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | - Ann Hagell
- Association for Young People's Health, London, UK
| | | | - Helen Skirrow
- School of Public Health, Imperial College London, London, UK
| | | | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | | | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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2
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Racine E, O Mahony L, Riordan F, Flynn G, Kearney PM, McHugh SM. What and how do different stakeholders contribute to intervention development? A mixed methods study. HRB Open Res 2022; 5:35. [PMID: 36895913 PMCID: PMC9989546 DOI: 10.12688/hrbopenres.13544.1] [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: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: UK Medical Research Council guidelines recommend end-user involvement in intervention development. There is limited evidence on the contributions of different end-users to this process. The aim of this Study Within A Trial (SWAT) was to identify and compare contributions from two groups of end-users - people with diabetes' (PWD) and healthcare professionals' (HCPs), during consensus meetings to inform an intervention to improve retinopathy screening uptake. Methods: A mixed method, explanatory sequential design comprising a survey and three semi-structured consensus meetings was used. PWD were randomly assigned to a diabetes only or combined meeting. HCPs attended a HCP only or combined meeting, based on availability. In the survey, participants rated intervention proposals on acceptability and feasibility. Survey results informed the meeting topic guide. Transcripts were analysed deductively to compare feedback on intervention proposals, suggestions for new content, and contributions to the final intervention. Results: Overall, 13 PWD and 17 HCPs completed the survey, and 16 PWD and 15 HCPs attended meetings. For 31 of the 39 intervention proposals in the survey, there were differences (≥10%) between the proportion of HCPs and PWD who rated proposals as acceptable and/or feasible. End-user groups shared and unique concerns about proposals; both were concerned about informing but not scaring people when communicating risk, while concerns about resources were mostly unique to HCPs and concerns about privacy were mostly unique to PWD. Fewer suggestions for new intervention content from the combined meeting were integrated into the final intervention as they were not feasible for implementation in general practice. Participants contributed four new behaviour change techniques not present in the original proposals: goal setting (outcome), restructuring the physical environment, material incentive (behaviour) and punishment. Conclusions: Preferences for intervention content may differ across end-user groups, with feedback varying depending on whether end-users are involved simultaneously or separately.
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Affiliation(s)
- Emmy Racine
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Lauren O Mahony
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Gráinne Flynn
- PPI Contributor, IDEAs Research Project, University College Cork, Cork, T12 K8AF, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
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3
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Racine E, O Mahony L, Riordan F, Flynn G, Kearney PM, McHugh SM. What and how do different stakeholders contribute to intervention development? A mixed methods study. HRB Open Res 2022; 5:35. [PMID: 36895913 PMCID: PMC9989546 DOI: 10.12688/hrbopenres.13544.2] [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: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Background: UK Medical Research Council guidelines recommend end-user involvement in intervention development. There is limited evidence on the contributions of different end-users to this process. The aim of this Study Within A Trial (SWAT) was to identify and compare contributions from two groups of end-users - people with diabetes' (PWD) and healthcare professionals' (HCPs), during consensus meetings to inform an intervention to improve retinopathy screening uptake. Methods: A mixed method, explanatory sequential design comprising a survey and three semi-structured consensus meetings was used. PWD were randomly assigned to a PWD only or combined meeting. HCPs attended a HCP only or combined meeting, based on availability. In the survey, participants rated intervention proposals on acceptability and feasibility. Survey results informed the meeting topic guide. Transcripts were analysed deductively to compare feedback on intervention proposals, suggestions for new content, and contributions to the final intervention. Results: Overall, 13 PWD and 17 HCPs completed the survey, and 16 PWD and 15 HCPs attended meetings. For 31 of the 39 intervention proposals in the survey, there were differences (≥10%) between the proportion of HCPs and PWD who rated proposals as acceptable and/or feasible. End-user groups shared and unique concerns about proposals; both were concerned about informing but not scaring people when communicating risk, while concerns about resources were mostly unique to HCPs and concerns about privacy were mostly unique to PWD. Fewer suggestions for new intervention content from the combined meeting were integrated into the final intervention as they were not feasible for implementation in general practice. Participants contributed four new behaviour change techniques not present in the original proposals: goal setting (outcome), restructuring the physical environment, material incentive (behaviour) and punishment. Conclusions: Preferences for intervention content may differ across end-user groups, with feedback varying depending on whether end-users are involved simultaneously or separately.
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Affiliation(s)
- Emmy Racine
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Lauren O Mahony
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Gráinne Flynn
- PPI Contributor, IDEAs Research Project, University College Cork, Cork, T12 K8AF, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
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4
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Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
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Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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5
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McCarron TL, Clement F, Rasiah J, Moran C, Moffat K, Gonzalez A, Wasylak T, Santana M. Patients as partners in health research: A scoping review. Health Expect 2021; 24:1378-1390. [PMID: 34153165 PMCID: PMC8369093 DOI: 10.1111/hex.13272] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of patient involvement in health research has evolved over the past decade. Despite efforts to engage patients as partners, the role is not well understood. We undertook this review to understand the engagement practices of patients who assume roles as partners in health research. METHODS Using a recognized methodological approach, two academic databases (MEDLINE and EMBASE) and grey literature sources were searched. Findings were organized into one of the three higher levels of engagement, described by the Patient and Researcher Engagement framework developed by Manafo. We examined and quantified the supportive strategies used during involvement, used thematic analysis as described by Braun and Clarke and themed the purpose of engagement, and categorized the reported outcomes according to the CIHR Engagement Framework. RESULTS Out of 6621 records, 119 sources were included in the review. Thematic analysis of the purpose of engagement revealed five themes: documenting and advancing PPI, relevance of research, co-building, capacity building and impact on research. Improved research design was the most common reported outcome and the most common role for patient partners was as members of the research team, and the most commonly used strategy to support involvement was by meetings. CONCLUSION The evidence collected during this review advanced our understanding of the engagement of patients as research partners. As patient involvement becomes more mainstream, this knowledge will aid researchers and policy-makers in the development of approaches and tools to support engagement. PATIENT/USER INVOLVEMENT Patients led and conducted the grey literature search, including the synthesis and interpretation of the findings.
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Affiliation(s)
- Tamara L. McCarron
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Fiona Clement
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Jananee Rasiah
- Faculty of Nursing3‐141 Edmonton Clinic Health Academy (ECHA)University of AlbertaEdmontonABCanada
| | - Chelsea Moran
- The Department PsychologyUniversity of CalgaryCalgaryABCanada
| | - Karen Moffat
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
- Patient PartnerCalgaryABCanada
| | - Andrea Gonzalez
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Tracy Wasylak
- Alberta Health ServicesCalgaryABCanada
- Faculty of NursingUniversity of CalgaryCalgaryABCanada
| | - Maria Santana
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
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6
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Lowry M, Morrissey EC, Dinneen SF. Piloting an Intervention to Improve Outcomes in Young Adults Living With Type 1 Diabetes: The Experience of the D1 Now Support Worker. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:799589. [PMID: 36994338 PMCID: PMC10012156 DOI: 10.3389/fcdhc.2021.799589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
IntroductionD1 Now is a novel intervention which aims to support self-management and clinic engagement and improve outcomes in young adults (18-25 years) living with type 1 diabetes in Ireland. It has been developed using a systematic, theoretical, user-centred approach. The specific role of the Support Worker, one of three components of the D1 Now intervention, was developed to provide continuity and build relationships between young adults and their diabetes team.MethodsA Support Worker - an Occupational Therapist, who had a background in youth mental health - was hired as part of the D1 Now pilot randomised controlled trial and was based in one intervention site to join the existing diabetes team.DiscussionThe Support Worker aimed to provide an accessible and consistent point of contact for young adults, facilitated conversations about distress, and encouraged graded goal setting and collaborative problem solving. The role afforded her with a unique window into the lived experiences of young adults with type 1 diabetes where she observed the ongoing negotiation of life and living alongside diabetes care and management. The prevalence of diabetes distress was high in the study cohort with particular challenges associated with ‘all or nothing’ thinking patterns as well as disordered eating behaviours. The Support Worker also played an advocacy role in supporting the diabetes team’s awareness of young adults’ needs and explored current barriers to care. Preliminary findings from the D1 Now pilot have identified that the role of the Support Worker was viewed positively from the perspective of young adults with type 1 diabetes.
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Affiliation(s)
- Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
- *Correspondence: Michelle Lowry,
| | - Eimear C. Morrissey
- School of Medicine, National University of Ireland, Galway, Ireland
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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Racine E, Riordan F, Phillip E, Flynn G, McHugh S, Kearney PM. 'It just wasn't going to be heard': A mixed methods study to compare different ways of involving people with diabetes and health-care professionals in health intervention research. Health Expect 2020; 23:870-883. [PMID: 32356592 PMCID: PMC7495083 DOI: 10.1111/hex.13061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/20/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Guidelines recommend involving intervention users in the intervention development process. However, there is limited guidance on how to involve users in a meaningful and effective way. Objective The aim of this Study within a trial was to compare participants’ experiences of taking part in one of three types of consensus meetings—people with diabetes‐only, combined people with diabetes and health‐care professionals (HCPs) or HCP‐only meeting. Design The study used a mixed methods convergent design. Quantitative (questionnaire) and qualitative (observation notes and semi‐structured telephone interviews) data were collected to explore participants’ experiences. A triangulation protocol was used to compare quantitative and qualitative findings. Participants People with diabetes (recruited via multiple strategies) were randomly assigned to attend the people with diabetes or combined meeting. HCPs (recruited through professional networks) attended the HCP or combined meeting based on their availability. Results Sixteen people with diabetes and 15 HCPs attended meetings, of whom 18 participated in a telephone interview. Participants’ questionnaire responses suggested similar positive experiences across the three meetings. Observation and semi‐structured interviews highlighted differences experienced by participants in the combined meeting relating to: perceived lack of common ground; feeling empowered versus undervalued; needing to feel safe and going off task to fill the void. Conclusions The qualitative theme ‘needing to feel safe’ may explain the dissonance (disagreement) between quantitative and qualitative data. In this study, involving patients and HCPs simultaneously in a consensus process was not found to be as suitable as involving each stakeholder group separately.
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Affiliation(s)
- Emmy Racine
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Eunice Phillip
- School of Public Health, University College Cork, Cork, Ireland
| | - Grainne Flynn
- Independent Patient and Public Involvement Partner, Co. Clare, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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8
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Bell JS, Murray FE, Davies EL. An investigation of the features facilitating effective collaboration between public health experts and data scientists at a hackathon. Public Health 2019; 173:120-125. [PMID: 31271966 DOI: 10.1016/j.puhe.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study is to explore facilitating factors for collaboration at hackathons, intensive events bringing together data scientists ('hackers') with experts in particular subject areas. STUDY DESIGN This is a qualitative study. METHODS Semistructured interviews were conducted with organisers before and after the event. The initial exploratory interviews influenced the content of questionnaires which were distributed to all participants asking about their motivations and experiences. Thematic analysis was used to explore key features of collaboration. RESULTS Facilitating factors were clustered under the themes of preparation (the right amount of pre-event information, methods to maximise attendance and identification of suitable challenges), participants (enough people to progress and a mixture of skills and experience), working together (mutual understanding of the aim, getting the best out of each other, overcoming challenges together, effective facilitation and an enjoyable and valuable experience) and follow-up (recognised process for feedback and support for the development of prototypes). CONCLUSIONS The findings of the study provide insight into fostering collaboration in this context and provide evidence that may be used to tailor future events for the effective delivery of technological and marketing-based solutions to public health challenges. Hackathons provide a methodological advance with potential for broad public health application.
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Affiliation(s)
- J S Bell
- Public Health Directorate, National Health Service (NHS) Grampian, Aberdeen, Scotland.
| | - F E Murray
- Public Health Directorate, National Health Service (NHS) Grampian, Aberdeen, Scotland
| | - E L Davies
- Public Health Directorate, National Health Service (NHS) Grampian, Aberdeen, Scotland
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9
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Klaprat N, MacIntosh A, McGavock JM. Gaps in Knowledge and the Need for Patient-Partners in Research Related to Physical Activity and Type 1 Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2019; 10:42. [PMID: 30787908 PMCID: PMC6372552 DOI: 10.3389/fendo.2019.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
Regular physical activity (PA) is a cornerstone in the management of complications associated with type 1 diabetes (T1D). Most national guidelines advocate for regular PA for persons living with T1D, however the evidence to support these recommendations has not be reviewed recently. Additionally, in an era of patient-centered care and patient oriented research, the role of patient partners in the area of PA and T1D interventions has never been explored. The purpose of this narrative review is to overcome these two gaps in the literature. Here we review selected epidemiological evidence and identify gaps in research that would add important information to guide practitioners and future guidelines. We also provide an overview of patient-oriented research projects co-developed with persons living with T1D. Significant gaps in the field include: (1) a lack of adequately powered prospective cohort studies using serial measures of PA and hard chronic disease end-points; (2) no multi-centered, highly powered, randomized controlled trials of PA, and long-term health outcomes; (3) little data on the role of new technologies to support PA-related behavior change, and (4) no trials that involved patients in the design and execution of PA-based clinical trials. This review provides a template for scientists and patient partners to develop future research priorities and agendas in the field.
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Affiliation(s)
- Nika Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan M. McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada SPOR Network, Toronto, ON, Canada
- *Correspondence: Jonathan M. McGavock
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10
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Calamaro CJ, Saylor J, Hanna KM. Health Care Experience of Young Adults Diagnosed With Type 1 Diabetes. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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11
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018. [PMID: 32002502 DOI: 10.12688/hrbopenres.12803.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018; 1:8. [PMID: 32002502 PMCID: PMC6973524 DOI: 10.12688/hrbopenres.12803.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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