‘It's an important part, but I am not quite sure that it is working’: educators’ perspectives on the implementation of goal‐setting within the ‘DAFNE’ diabetes structured education programme

Fredrix, Milou; Byrne, Molly; Dinneen, Seán F.; McSharry, Jenny

doi:10.1111/dme.13813

Cited by 14 publications

(15 citation statements)

References 27 publications

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“…Importantly, although outcome (weight) measurement frequently happened in the intervention sessions and were fed back to participants, they were not often reviewed with participants so they could modify their goals in light of failure or success. Similar underdelivery of self-regulation techniques such as goal setting and action planning has been noted in other studies [ 27 ]. Other BCTs that were underdelivered by all providers were those that involved monitoring behavior such as via diaries or pedometers without feedback, prompting consideration of pro’s and con’s, and providing emotional social support.…”

Section: Discussionsupporting

confidence: 76%

Is the NHS Diabetes Prevention Programme Intervention Delivered as Planned? An Observational Study of Fidelity of Intervention Delivery

French

Hawkes

Bower

et al. 2021

Annals of Behavioral Medicine

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Background The NHS Diabetes Prevention Programme (NHS-DPP) has been delivered by four commercial organizations across England, to prevent people with impaired glucose tolerance developing Type 2 diabetes. Evidence reviews underpinning the NHS-DPP design specification identified 19 Behavior Change Techniques (BCTs) that are the intervention “active ingredients.” It is important to understand the discrepancies between BCTs specified in design and BCTs actually delivered. Purpose To compare observed fidelity of delivery of BCTs that were delivered to (a) the NHS-DPP design specification, and (b) the programme manuals of four provider organizations. Methods Audio-recordings were made of complete delivery of NHS-DPP courses at eight diverse sites (two courses per provider organization). The eight courses consisted of 111 group sessions, with 409 patients and 35 facilitators. BCT Taxonomy v1 was used to reliably code the contents of NHS-DPP design specification documents, programme manuals for each provider organization, and observed NHS-DPP group sessions. Results The NHS-DPP design specification indicated 19 BCTs that should be delivered, whereas only seven (37%) were delivered during the programme in all eight courses. By contrast, between 70% and 89% of BCTs specified in programme manuals were delivered. There was substantial under-delivery of BCTs that were designed to improve self-regulation of behavior, for example, those involving problem solving and self-monitoring of behavior. Conclusions A lack of fidelity in delivery to the underlying evidence base was apparent, due to poor translation of design specification to programme manuals. By contrast, the fidelity of delivery to the programme manuals was relatively good. Future commissioning should focus on ensuring the evidence base is more accurately translated into the programme manual contents.

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Section: Discussionsupporting

confidence: 76%

Is the NHS Diabetes Prevention Programme Intervention Delivered as Planned? An Observational Study of Fidelity of Intervention Delivery

French

Hawkes

Bower

et al. 2021

Annals of Behavioral Medicine

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“…Moreover, discussing goals in the groups may be helpful not only to increase accountability but also to provide feedback on the quality of action plans. However, facilitators too may find goal setting and action planning challenging and may need more specific training on it (Fredrix, Byrne, Dinneen, & McSharry, 2018).…”

Section: Discussionmentioning

confidence: 99%

‘We're all in the same boat’: A qualitative study on how groups work in a diabetes prevention and management programme

Borek

Abraham

Greaves

et al. 2019

British J Health Psychol

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What is already known on this subject?Many health interventions, including programmes to help prevent or manage diabetes and facilitate weight loss, are delivered in groups. Such group-based behaviour-change interventions are often effective in facilitating psychological and behaviour change. There is considerable research and theory on individual change processes and techniques, but less is known about which change processes and techniques facilitate behaviour change in group settings. What does this study add?This study contributes to our understanding of how participating in group-based health programmes may enhance or impede individual behaviour change. It identified individual (intrapersonal) and group (interpersonal, facilitated through group interaction) change processes that were valued by group participants. The findings also show how these change processes may be affected by the group context. A diagram summarizes the identified themes helping to understand interactions between these key processes occurring in groups.The study offers an insight into participants' views on, and experiences of, attending a group-based diabetes prevention and management programme. Thus, it helps better understand how the intervention might have helped them (or not) and what processes may have influenced intervention outcomes. Key practical recommendations for designing and delivering group-based behaviour-change interventions are presented, which may be used to improve future group-based health interventions.

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“…While HCPs generally recognise the importance of providing psychological and social support for adults with diabetes, 14 15 studies have reported minimal inclusion of such issues in routine diabetes care due to lack of training, tools and skills to engage in conversations about psychological and social aspects. [16][17][18] Furthermore, access to specialist psychology services is limited in most areas. Structural barriers such as consultation time constraints due to a focus on fulfilling the requirements set by clinical guidelines and an emphasis on glucose targets also limit the capacity for psychological and social support.…”

Section: Introductionmentioning

confidence: 99%

A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK

et al. 2021

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ObjectiveTo develop supportive interventions for adults with new-onset type 1 diabetes (T1D) to facilitate positive adaptive strategies during their transition into a life with diabetes.DesignThe study used a co-design approach informed by Design Thinking to stimulate participants’ reflections on their experiences of current care and generate ideas for new supportive interventions. Visual illustrations were used to depict support needs and challenges. Initial discussions of these needs and challenges were facilitated by researchers and people with diabetes in workshops. Data comprising transcribed audio recordings of the workshop discussions and materials generated during the workshops were analysed thematically.SettingsSpecialised diabetes centres in Denmark and the United Kingdom.ParticipantsAdults with new-onset T1D (n=24) and healthcare professionals (HCPs) (n=56) participated in six parallel workshops followed by four joint workshops with adults (n=29) and HCPs (n=24) together.ResultsThe common solution prioritised by both adults with new-onset T1D and HCP participants was the development of an integrated model of care addressing the psychological and social elements of the diagnosis, alongside information on diabetes self-management. Participants also indicated a need to develop the organisation, provision and content of care, along with the skills HCPs need to optimally deliver that care. The co-designed interventions included three visual conversation tools that could be used flexibly in the care of adults with new-onset T1D to support physical, psychological and social adaptation to T1D.ConclusionThis co-design study has identified the care priorities for adults who develop T1D, along with some practical conversational tools that may help guide HCPs in attending to the disruptive experience of the diagnosis and support adults in adjusting into a life with diabetes.

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‘It's an important part, but I am not quite sure that it is working’: educators’ perspectives on the implementation of goal‐setting within the ‘DAFNE’ diabetes structured education programme

Cited by 14 publications

References 27 publications

Is the NHS Diabetes Prevention Programme Intervention Delivered as Planned? An Observational Study of Fidelity of Intervention Delivery

Is the NHS Diabetes Prevention Programme Intervention Delivered as Planned? An Observational Study of Fidelity of Intervention Delivery

‘We're all in the same boat’: A qualitative study on how groups work in a diabetes prevention and management programme

A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK

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