A qualitative study of the perceptions and experiences of participants and healthcare professionals in the DiRECT‐Australia type 2 diabetes remission service

Abstract

BackgroundThe UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT‐Australia Type 2 Diabetes Remission Service.MethodsAll participants and HCPs delivering the service were invited to participate in semi‐structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT‐Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis.ResultsEight DiRECT‐Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT‐Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant‐HCP interactions and continuous support; (4) Acceptance and long‐term need for DiRECT‐Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT‐Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long‐term basis.ConclusionsBoth participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT‐Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long‐term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission.

Experiences and Acceptability of a Weight Loss Intervention for Diabetes (Diabetes Remission Clinical Trial—DiRECT) in Aotearoa New Zealand: A Qualitative Study within a Pilot Randomised Controlled Trial

“…Previous research has found DiRECT to be an acceptable approach for weight loss among people with type 2 diabetes [ 14 , 15 , 16 ]. In line with the process of adaptation we have reported, Rehackova et al describe a “fluctuation of experience” within the original DiRECT-UK trial [ 14 ] (p. 4).…”

“…The participants in our study and the DiRECT-UK trial each identified new and reoccurring challenges requiring resilience and tailored support. In fact, many of the experiences described by our participants appear universal: a desire for weight loss and better health as a stimulus for participation in a total diet replacement intervention [ 14 , 15 , 16 , 46 , 47 ]; the abrupt but worthwhile adjustment to a total diet replacement regimen [ 14 , 15 , 16 , 46 ]; professional support as a source of accountability [ 14 , 15 , 48 ]; drawing on rapid and early weight loss as an important motivator [ 14 , 15 , 48 ]; navigating the “disruption to adaptation” [ 14 ] (p. 7) posed by food reintroduction; the challenging realities of weight loss maintenance [ 14 , 16 , 46 , 47 , 48 , 49 ]; and the development of “behavioural autonomy” [ 49 ] (p. 956). As we identified, the timing and intensity of the challenges faced by individuals vary, and additional personal barriers frequently emerge [ 14 , 15 , 46 , 47 , 48 ].…”

“…Our research contributes a unique set of perspectives regarding DiRECT and dietitian-supported usual care to the existing literature, reflecting the experiences of participants engaged in cultures where food and eating carries increased sociocultural significance. In contrast, previous qualitative evaluations of DiRECT have been conducted in samples with limited ethnic and cultural diversity [ 14 , 16 ].…”

“…The success of any dietary intervention is invariably linked to its acceptability or social validity [ 12 , 13 ]. Previous qualitative research has found DiRECT to be acceptable among people with type 2 diabetes [ 14 , 15 , 16 ] in studies of predominantly European populations. However, food and mealtimes serve an important symbolic purpose in many cultures globally, which may influence the acceptability of DiRECT elsewhere.…”

Remote Delivery of Partial Meal Replacement for Weight Loss in People Awaiting Arthroplasty

“…The PMR plan provided was 1200 calories per day (5020 kJ/day) for 12 weeks, which included meal replacement shakes or soups to cover two meals per day, and a third suitable simple meal option. The low-calorie meal replacement shakes (Example—in serving size: 54 g chocolate shake, 845 kJ energy, 3.3 g fat, 21.4 g carbohydrate and 20.1 g protein) used in this study were previously used in the DiRECT-Australia study [ 37 , 39 ]. These shakes/soups were provided free of cost to all participants by the research team.…”