Lay Health Trainers Supporting Self-Management amongst Those with Low Heath Literacy and Diabetes: Lessons from a Mixed Methods Pilot, Feasibility Study

Abstract

This article reports a mixed methods process evaluation of a pilot feasibility randomised controlled trial comparing a Lay Health Trainer (LHT) intervention and usual care for those with poorly controlled Type 2 Diabetes Melitus (T2DM). Set in a deprived area in the UK, this research explores patient and health care practitioner (HCP) views on whether a structured interview between a patient and a Lay Health Trainer (LHT), for the purpose of developing a tailored self-management plan for patients, is acceptable and likely to change health behaviours. In doing so, it considers the implications for a future, randomised controlled trial (RCT). Participants were patients, LHTs delivering the intervention, service managers, and practice nurses recruiting patients to the study. Patients were purposively sampled on their responses to a baseline survey, and semistructured interviews were conducted within an exploratory thematic analysis framework. Findings indicate that the intervention is acceptable to patients and HCPs. However, LHTs found it challenging to work with older patients with long-term and/or complex conditions. In order to address this, given an ageing population and concomitant increases in those with such health needs, LHT training should develop skills working with these populations. The design of any future RCT intervention should take account of this.

Educational Interventions for Promoting Food Literacy and Patient Engagement in Preventing Complications of Type 2 Diabetes: A Systematic Review

“…The articles included for the analyses ranged from 2003 to 2019 and were conducted in 13 different countries. The majority of the studies were conducted in the USA (n. 15) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]; three in Iran [ 45 , 46 , 47 ] and Korea [ 8 , 48 , 49 ]; two in Canada [ 50 , 51 ] and the UK [ 52 , 53 ]; one in China [ 7 ], Belgium [ 6 ], Bulgaria [ 54 ], Hong Kong [ 55 ], Japan [ 56 ], Malaysia [ 57 ], Mexico [ 58 ], and Taiwan [ 59 ]. Considering articles’ design the majority (n. 21) was a Randomized Control Trial [ 7 , 8 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 45 , 47 , 48 , 49 , 51 , 52 , 53 , 57 ]; seven were a pre-post study [ ...…”

“…Fourteen articles considered all these different types of outcomes together [ 6 , 30 , 31 , 32 , 34 , 38 , 40 , 44 , 49 , 50 , 52 , 54 , 57 , 59 ]; one article considered behavioral, psychological, and literacy outcomes [ 43 ]; one article considered clinical, behavioral, and psychological outcomes [ 49 ]; one article considered clinical, psychological, and literacy outcomes [ 41 ]; one article considered psychological and literacy outcomes [ 45 ]; one article considered behavioral and literacy outcomes [ 51 ]; six articles considered only clinical outcomes [ 33 , 35 , 39 , 48 , 56 , 58 ]; four articles considered only literacy [ 36 , 37 , 42 , 53 ]; and four articles considered only psychological outcomes [ 7 , 46 , 47 , 55 ].…”

“…We classified the articles on the basis of the way patient engagement (as intended in this review) was conceptualized in the studies. In greater detail, fifteen articles conceptualized it as self-management alone [ 32 , 33 , 36 , 42 , 52 , 53 ] or together with other variables, such as quality of life, patient participation, or self-efficacy [ 6 , 8 , 35 , 38 , 40 , 44 , 47 , 48 , 51 ]. Seven articles described some kind of participation of the patients or the families into the definition or the adjustment of the intervention [ 30 , 31 , 34 , 37 , 41 , 46 , 54 ] in order to consider their opinion and to better target the intervention itself.…”

“…The majority of the interventions (n = 27) described targeted individual patients [ 7 , 8 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 52 , 53 , 54 , 55 , 56 , 57 ]; four targeted patient groups [ 38 , 41 , 51 , 59 ]; and two both individuals and groups [ 6 , 58 ].…”

“…In five articles, the researchers provided the intervention itself [ 7 , 43 , 46 , 47 , 59 ]. Four articles were by lay workers [ 38 , 41 , 52 , 53 ]. Three articles were by educators [ 6 , 40 ], in one case alternatively to a health professional [ 6 ].…”