Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol

Abstract

IntroductionSelf-management is deemed the cornerstone in overall diabetes management. Web-based self-management interventions have potential to support adults with type 2 diabetes (T2DM) in managing their disease. Owing to somewhat ambiguous results of such interventions, interventions should be theory-based and incorporate well-defined counselling methods and techniques for behavioural change. This study is designed to assess the effectiveness of a theory-driven web-based Guided Self-Determination (GSD) intervention among adults with T2DM in general practice to improve diabetes self-management behaviours and glycosylated haemoglobin (HbA1c).Methods and analysisA complex intervention design based on the framework of the UK Medical Research Council is employed as a guide for developing the intervention, assessing its feasibility and evaluating its effectiveness. The study consists of three phases: (1) the modelling phase adapting the original GSD programme for adults with T2DM, using a qualitative design, (2) feasibility assessment of the adapted intervention on the web, employing qualitative and quantitative methods and (3) evaluating the effectiveness of the intervention on diabetes self-management behaviours and HbA1c, using a quasi-experimental design. The first phase, which is completed, and the second phase, which is underway, will provide important information about the development of the intervention and its acceptability, whereas the third phase will assess the effectiveness of this systematically developed intervention.Ethics and disseminationThe Norwegian Regional Committee for Medical and Health Research Ethics (REK west number 2015/60) has approved the study design. Patients recruited in the different phases will fill out an informed consent form prior to inclusion and will be guaranteed anonymity and the right to withdraw from the study at any time. The results of the study will be published in peer-reviewed journals, electronically and in print, and presented at research conferences.Trial registration number:NCT02575599.

New Possibilities in Life with Type 2 Diabetes: Experiences from Participating in a Guided Self-Determination Programme in General Practice

“…Given the increasing prevalence of T2DM and the somewhat ambiguous research results, there is still a need for ongoing educational and behavioural support to deliver self-management support interventions for people with T2DM. As a result, we modified a GSD programme for use by adults with T2DM [ 10 ]. The GSD programme aims to support diabetes self-management by empowering self-determined goals and competence building among people who have difficulties in diabetes management [ 11 ].…”

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study

“…The current study, which was conducted as a pilot study, is part of a larger project that developed a complex eHealth intervention for adults with T2DM who are treated in general practices in Norway. 12 We used a qualitative design in which data were collected through individual interviews that were conducted between December 2015 and December 2016. Interviews provide valuable information on patients’ experiences and opinions, which is important when piloting clinical interventions in real-life contexts.…”

“…Based on these recommendations, in the development phase of our project, we adapted the Guided Self-Determination (GSD) self-management support program to be an eHealth intervention for adults with T2DM. 12 Originally, the GSD program was developed for type 1 diabetes, and research indicates that the program is effective in facilitating the development of life skills and lowering psychosocial distress. 13 – 20 …”

“… 13 Such expression and active participation can empower patients to become self-determined and develop the skills necessary for adequate self-management of diabetes. 12 Written reflection requires the translation of emotions and experiences into words, and this cognitive process can benefit individuals in a variety of situations. 29 The use of writing as a therapeutic approach has been examined in a variety of populations, including college students who are vulnerable to depression, cancer survivors, and individuals with chronic pain and various physical diseases, and findings indicate that this approach can improve treatment outcomes and quality of life.…”

Reconfiguring clinical communication in the electronic counselling context: The nuances of disruption

“…In this study, the eHealth intervention was based on GSD developed for people with type 2 diabetes (Karlsen et al, ). The GSD is a theory‐driven counselling approach founded in the synthesis of grounded theories, self‐determination theory, life skills theory and humanistic values theory (Zoffmann et al, ; Zoffmann, Harder, & Kirkevold, ).…”