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. 2020 May 22:6:71.
doi: 10.1186/s40814-020-00606-0. eCollection 2020.

Increasing uptake of structured self-management education programmes for type 2 diabetes in a primary care setting: a feasibility study

Melanie Davies  1 , Caroline A Kristunas  1   2 , Lisa Huddlestone  2 , Abualbishr Alshreef  3 , Danielle Bodicoat  1 , Simon Dixon  3 , Helen Eborall  2 , Agnieszka Glab  4 , Nicky Hudson  5 , Kamlesh Khunti  1 , Graham Martin  6 , Alison Northern  4 , Mike Patterson  4 , Rebecca Pritchard  4 , Sally Schreder  4 , Bernie Stribling  4 , Jessica Turner  5 , Laura J Gray  2
Affiliations

Increasing uptake of structured self-management education programmes for type 2 diabetes in a primary care setting: a feasibility study

Melanie Davies et al. Pilot Feasibility Stud. .

Abstract

Background: Structured self-management education (SSME) for people with type 2 diabetes mellitus (T2DM) improves biomedical and psychological outcomes, whilst being cost-effective. Yet uptake in the UK remains low. An 'Embedding Package' addressing barriers and enablers to uptake at patient, health care professional and organisational levels has been developed. The aim of this study was to test the feasibility of conducting a subsequent randomised controlled trial (RCT) to evaluate the Embedding Package in primary care, using a mixed methods approach.

Methods: A concurrent mixed methods approach was adopted. Six general practices in the UK were recruited and received the intervention (the Embedding Package). Pseudonymised demographic, biomedical and SSME data were extracted from primary care medical records for patients recorded as having a diagnosis of T2DM. Descriptive statistics assessed quantitative data completeness and accuracy. Quantitative data were supplemented and validated by a patient questionnaire, for which two recruitment methods were trialled. Where consent was given, the questionnaire and primary care data were linked and compared. The cost of the intervention was estimated. An integrated qualitative study comprising ethnography and stakeholder and patient interviews explored the process of implementation, sustainability of change and 'fit' of the intervention. Qualitative data were analysed using a thematic framework guided by the Normalisation Process Theory (NPT).

Results: Primary care data were extracted for 2877 patients. The primary outcome for the RCT, HbA1c, was over 90% complete. Questionnaires were received from 423 (14.7%) participants, with postal invitations yielding more participants than general practitioner (GP) prompts. Ninety-one percent of questionnaire participants consented to data linkage. The mean cost per patient for the Embedding Package was £8.94, over a median follow-up of 162.5 days. Removing the development cost, this reduces to £5.47 per patient. Adoption of ethnographic and interview methods in the collection of data was appropriate, and the use of NPT, whilst challenging, enhanced the understanding of the implementation process. The need to delay the collection of patient interview data to enable the intervention to inform patient care was highlighted.

Conclusions: It is feasible to collect data with reasonable completeness and accuracy for the subsequent RCT, although refinement to improve the quality of the data collected will be undertaken. Based on resource use data collected, it was feasible to produce cost estimates for each individual component of the Embedding Package. The methods chosen to generate, collect and analyse qualitative data were satisfactory, keeping participant burden low and providing insight into potential refinements of the Embedding Package and customisation of the methods for the RCT.

Trial registration: ISRCTN, ISRCTN21321635, Registered 07/07/2017-retrospectively registered.

Keywords: Feasibility study; Structured self-management education; Type 2 diabetes.

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Conflict of interest statement

Competing interestsThere are no conflicts of interest; however, for transparency, the following are provided: MD is the Principal Investigator (PI) on the DESMOND programme (Diabetes education and self-management for people with newly diagnosed Type 2 diabetes). BS, SS and AN are employed by the University Hospitals of Leicester NHS Trust, which receives not-for-profit income for DESMOND. MD, KK, HE, LG, AN, SS and BS are actively engaged in research and have previously received grants for DESMOND from NIHR, MRC and Diabetes UK to develop and test Diabetes Self-Management Education and Support programmes like DESMOND. The University Hospitals of Leicester (UHL) NHS Trust (for which BS, SS and AN have a contract) receives licensing fees to support implementation of the DESMOND programme in CCGs in the UK, Ireland and Australia. All other authors have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the quantitative data collection process
Fig. 2
Fig. 2
Findings from the ethnographic study, grouped by organisational, intervention and team factors
See this image and copyright information in PMC

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