Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study (Preprint)

Abstract

<sec> <title>BACKGROUND</title> <p>Participation in a 16-week, reverse-integrated care, group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (HbA1C) and body mass index (BMI).</p> </sec> <sec> <title>OBJECTIVE</title> <p>Here we aimed to identify elements of patient experience and evaluate predictors of outcome.</p> </sec> <sec> <title>METHODS</title> <p>In order to better understand key components of the intervention, quantitative and qualitative data were collected utilizing a mixed methods case study framework. Mixed effects modeling was performed to identify predictors of improved HbA1C and BMI. Semi-structured individual interviews were conducted with 24/35 (69%) of those who attended one or more group sessions and 9/25 (36%) of those who consented but attended no sessions. Independent qualitative and quantitative analytics were integrated thematically.</p> </sec> <sec> <title>RESULTS</title> <p>No factors tested were significantly associated with improved HbA1C. Improved diabetes knowledge was associated with reduced BMI (P=0.003). Qualitative interviews identified health-related knowledge gains and application to real world situations, positive reinforcement by group leaders and peers, accountability for goals, group support, and increased confidence in the ability to prioritize health goals as factors contributing to success of the behavioral intervention from the participants’ perspective.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>This mixed methods analysis supports further study of a combined educational and behavioral intervention for diabetes self-management in adults with diabetes and serious mental illness in which improved diabetes knowledge was associated with weight loss. Participants highlighted the value of the group model as well as positive reinforcement, accountability, and real-world application of knowledge gained for improving health related knowledge, behavior, and outcomes.</p> </sec>