1
|
De Baets S, Danhieux K, Dirinck E, Lapauw B, Wouters E, Remmen R, van Olmen J. Journey Through Healthcare of People With Complications of Type 2 Diabetes: A Qualitative Study of Lived Experiences. Int J Integr Care 2024; 24:18. [PMID: 38798720 PMCID: PMC11122697 DOI: 10.5334/ijic.7604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Background Despite its overall good performance, the Belgium healthcare system scores less well in providing equal access to healthcare compared to other European countries. This increases the risk of people worse off to receive late diagnosis and to get complications of chronic diseases. Methods This study aims to achieve a deeper understanding of how people with complications of a chronic disease - diabetes type 2 - experience care in the Belgium health system through semi-structured interviews with extreme case study sampling of people with advanced diabetes, and inductive analysis. Results The results show that most respondents were diagnosed late in the course of their disease. There are variations in treatment and type of provider. People appreciate the personal and long-lasting contact with a medical doctor, while the contact with and role of paramedical providers was less recognized. Disease management has a significant impact on their financial budget and some respondents experienced barriers to obtain additional financial support. Discussion Non-medical costs are not reimbursed, presenting a high burden to people. Self-management is tedious and hampered by other worries that people may have, such as financial constraints and coping with important life events. To conclude this study highlighted the need to improve diabetes screening. We suggest to enhance the role of paramedical professionals, integrate a social care worker, reduce financial constraints, and increase health literacy through more patient-centered, goal-oriented care.
Collapse
Affiliation(s)
- Stijn De Baets
- Ghent University, Faculty of Medicine and Health sciences, department of rehabilitation sciences, Occupational therapy research group, Ghent, Belgium
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Frailty in ageing research group, Brussels, Belgium
| | - Katrien Danhieux
- Antwerp University, Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, Antwerp, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and metabolic disease, Antwerp, Belgium
| | - Bruno Lapauw
- Ghent University Hospital, Department of Endocrinology, Ghent, Belgium
| | - Edwin Wouters
- Antwerp University, Faculty of Social Sciences, Department of Sociology, Antwerp, Belgium
| | - Roy Remmen
- Antwerp University, Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, Antwerp, Belgium
| | - Josefien van Olmen
- Antwerp University, Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, Antwerp, Belgium
| |
Collapse
|
2
|
Yoon S, Goh H, Phang JK, Kwan YH, Low LL. Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study. Sci Rep 2023; 13:20554. [PMID: 37996479 PMCID: PMC10667337 DOI: 10.1038/s41598-023-47168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.
Collapse
Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore.
| | - Hendra Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- Population Health and Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| |
Collapse
|
3
|
Kone N, Cassim N, Maposa I, George JA. Diabetic control and compliance using glycated haemoglobin (HbA1C) testing guidelines in public healthcare facilities of Gauteng province, South Africa. PLoS One 2023; 18:e0278789. [PMID: 37585388 PMCID: PMC10431606 DOI: 10.1371/journal.pone.0278789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa, as well as factors associated with time to achieve control. South Africa's estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%. RESEARCH DESIGN, METHODS AND FINDINGS The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001). CONCLUSION This study highlights poor adherence to guidelines for diabetes monitoring.
Collapse
Affiliation(s)
- Ngalulawa Kone
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jaya Anna George
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| |
Collapse
|
4
|
Mukherjee PS, Ghosh S, Mukhopadhyay P, Das DK, Sarkar P, Majumdar S, Chatterjee K, Chowdhury A, Das K. Stepwise evaluation for the risk of metabolic unhealthiness and significant non-alcoholic fatty liver disease in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100142. [PMID: 37384057 PMCID: PMC10306046 DOI: 10.1016/j.lansea.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 06/30/2023]
Abstract
Background Non-communicable diseases including metabolic health disorders are becoming area of concern for low/middle income countries with poor health-care resources. Present study was planned to assess the prevalence of metabolically unhealthy (MU) subjects in the community and proportion of the MU subjects having the risk of significant Non-alcoholic Fatty Liver Disease (NAFLD) using a step-wise evaluation strategy in a resource-poor setting. Methods Study was performed in 19 community development blocks of Birbhum district, West Bengal, India. Every fifth member in the electoral list was included for the first step evaluation (n = 79,957/1,019,365, 7.8%) to detect any metabolic risk. Subjects with any metabolic risk in the first step (n = 9819/41,095, 24%) were taken for second step evaluation with Fasting blood glucose (FBG) and ALT. Subjects with elevated FBG and/or ALT in the second step (n = 1403/5283, 27%) were taken into third step evaluation. Finding At least one risk factor was found in 51.4% (n = 41,095/79,957). 63% (n = 885/1403) of the subjects with metabolic abnormality (third step) had MU state making its overall prevalence of 1.1% (n = 885/79,957). 53% of MU subjects (n = 470/885) had 'persistently elevated ALT' suggesting the risk of having significant NAFLD. Interpretation Step-wise evaluation strategy could detect the subjects at risk, actually having MU state and proportion of MU subjects at risk of having 'persistently elevated ALT' (surrogate of significant NAFLD) in the community with minimum utilization of scarce resources. Funding This study was funded by Bristol Myers Squibb Foundation, USA, under the program 'Together on Diabetes Asia' (Project Number: 1205 - LFWB).
Collapse
Affiliation(s)
- Partha Sarathi Mukherjee
- John C Martin Centre for Liver Research and Innovations (jcmlri.edu.in), Indian Institute of Liver and Digestive Sciences (IILDS), Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Division of Hepatology, Indian Institute of Liver and Digestive Sciences, Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGME&R), 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGME&R), 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Dipesh Kumar Das
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Pabak Sarkar
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Saibal Majumdar
- Division of Clinical service, Suri Sadar Hospital, Birbhum, PIN-731101, West Bengal, India
| | - Kajal Chatterjee
- Division of Clinical service, Suri Sadar Hospital, Birbhum, PIN-731101, West Bengal, India
| | - Abhijit Chowdhury
- John C Martin Centre for Liver Research and Innovations (jcmlri.edu.in), Indian Institute of Liver and Digestive Sciences (IILDS), Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Division of Hepatology, Indian Institute of Liver and Digestive Sciences, Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
- Department of Hepatology, School of Digestive and Liver Disease, Institute of Post Graduate Medical Education & Research, 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Kausik Das
- Department of Hepatology, School of Digestive and Liver Disease, Institute of Post Graduate Medical Education & Research, 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| |
Collapse
|
5
|
Trujillo-Minaya F, Vera-Ponce VJ, Torres-Malca JR, Zuzunaga-Montoya FE, Guerra Valencia J, De La Cruz-Vargas JA, Cruz-Ausejo L. Factores asociados al cribado de Diabetes Mellitus en población Peruana ¿problema para la salud pública? REVISTA CUIDARTE 2023. [DOI: 10.15649/cuidarte.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Highlights:
El ser varón es un factor relevante asociado al no tamizaje de diabetes mellitus tipo 2 (DM2).
Un mayor nivel de educación y socioeconómico se asocian positivamente con la posibilidad de realizarse tamizaje para DM2
El fortalecimiento de los servicios de atención primaria es crucial en la prevención primaria de DM2 a través del tamizaje.
Introducción: La Diabetes Mellitus tipo 2 es una enfermedad que representa un reto para la salud pública por su tendencia al crecimiento e impacto sobre todo en países en desarrollo. Objetivo: determinar los factores asociados a la no realización del cribado de diabetes mellitus tipo 2 según la encuesta demográfica y de salud familiar del año 2020 (ENDES-2020). Materiales y métodos: Estudio analítico transversal secundario de la ENDES-2020. Resultados: Las variables que mostraron asociación estadísticamente significativa para cribado de DM2 fueron: sexo masculino (PR=1,06, IC95% 1,02–1,10; p<0,001), edad entre 30 a 59 años (0,92; IC95% 0,89–0,95; p<0,001) y 60 años a más (PR=0,72; IC95% 0,65–0,79; p<0,001), educación primaria (PR=0,94, IC 95% 0,92 - 0,99; p<0,020), secundaria (PR=0,93; IC 95% 0,88–0,97; p=0,008) y superior (PR=0,86, IC 95% 0,85–0,94; p<0,001), ser pobre (PR=0,96, IC95% 0,92–0,99; p=0,016), medio (PR=0,93; IC95% 0,88 – 0,96; p=0,001), rico (PR=0,89; IC95% 0,84 – 0,94; p<0,001), muy rico (PR=0,81; IC95% 0,75–0,86; p<0,001), e hipertensión (PR=0,91; IC 95% 0,867–0,969; p=0,002). Discusión: El sexo masculino fue el único factor asociado a la no realización del cribado de diabetes mellitus tipo 2, mientras que, pertenecer a un grupo de edad mayor, tener hipertensión arterial, mayor nivel educativo y socioeconómico aumentó la posibilidad de realizarlo. Conclusión: Es imprescindible reforzar las estrategias de cribado en el primer nivel de atención, mediante la implementación de medidas de prevención.
Como citar este artículo: Fiorella Trujillo Minaya, Vera-Ponce Victor Juan, Torres-Malca Jenny Raquel, Zuzunaga-Montoya Fiorella E, Guerra Valencia Jamee, De la Cruz-Vargas Jhony A, Cruz Ausejo Liliana. Factores asociados al cribado de diabetes mellitus en población peruana ¿problema para la salud pública?. Revista Cuidarte. 2023;14(1):e2792. http://dx.doi.org/10.15649/cuidarte.2792
Collapse
|
6
|
Li C, Qin J, Liu W, Lv B, Yi N, Xue J, Xue Z. Profiling of Homocysteine Metabolic Pathway Related Metabolites in Plasma of Diabetic Mellitus Based on LC-QTOF-MS. Molecules 2023; 28:molecules28020656. [PMID: 36677712 PMCID: PMC9861464 DOI: 10.3390/molecules28020656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Homocysteine (Hcy) has been found to be closely related to the occurrence of diabetes mellitus (DM) and is considered as one of the risk factors of DM. However, Hcy alone is not enough as a factor to predict DM, and our study analyzed and determined the relationship between the main metabolites involved in the Hcy metabolic pathway and DM. Methods: A total of 48 clinical samples were collected, including 18 health control samples and 30 DM samples. All standards and samples were detected by LC-QTOF-MS. Multivariate statistical analysis and k-means cluster analysis were performed to screen and confirm the metabolites significantly correlated with DM. Results: A total of 13 metabolites of the Hcy metabolic pathway were detected in the samples. The content of Hcy, cysteine, taurine, pyridoxamine, methionine, and choline were significantly increased in the DM group (p < 0.05). Hcy, choline, cystathionine, methionine, and taurine contributed significantly to the probabilistic principal component analysis (PPCA) model. The odds ratios (OR) of Hcy, cysteine, taurine, methionine, and choline were all greater than one. K-means cluster analysis showed that the Hcy, taurine, methionine, and choline were significantly correlated with the distribution of glucose values (divided into four levels: 10.5−11.7 mmol/L, 7.7−9.7 mmol/L, 6.0−6.9 mmol/L, and 5.0−5.9 mmol/L, respectively). Conclusion: Hcy, taurine, methionine, and choline can be used as risk factors for diabetes diagnosis and are expected to be used for the assessment of diabetes severity.
Collapse
Affiliation(s)
- Chanyi Li
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Jiaying Qin
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Wuping Liu
- International Joint Research Center for Medical Metabolomics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Bo Lv
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Ning Yi
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Jinfeng Xue
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
- Correspondence: (J.X.); (Z.X.)
| | - Zhigang Xue
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
- Translational Center of Stem Cell Research, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
- Hunan Jiahui Genetics Hospital, 72 Xiangya Road, Changsha 410008, China
- Correspondence: (J.X.); (Z.X.)
| |
Collapse
|
7
|
Timm L, Annerstedt KS, Ahlgren JÁ, Absetz P, Alvesson HM, Forsberg BC, Daivadanam M. Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes. PLoS One 2022; 17:e0275576. [PMID: 36201441 PMCID: PMC9536591 DOI: 10.1371/journal.pone.0275576] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm. Methods This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon’s TFA. Exploratory factor analysis (EFA) was performed. Results Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38–65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden. Conclusions The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon’s TFA, with a wider variation in perceived burden seen among high risk and younger participants.
Collapse
Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | | | - Jhon Álvarez Ahlgren
- Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
van Olmen J, Absetz P, Mayega RW, Timm L, Delobelle P, Alvesson HM, Naggayi G, Kasujja F, Hassen M, de Man J, Sidney Annerstedt K, Puoane T, Östenson CG, Tomson G, Guwatudde D, Daivadanam M. Process evaluation of a pragmatic implementation trial to support self-management for the prevention and management of type 2 diabetes in Uganda, South Africa and Sweden in the SMART2D project. BMJ Open Diabetes Res Care 2022; 10:e002902. [PMID: 36162865 PMCID: PMC9516210 DOI: 10.1136/bmjdrc-2022-002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems. Process evaluations facilitate understanding why and how interventions work through analyzing the interaction between intervention theory, implementation and context. The Self-Management and Reciprocal Learning for Type 2 Diabetes project implemented and evaluated community-based interventions (peer support program; care companion; and link between facility care and community support) for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. RESEARCH DESIGN AND METHODS This paper reports implementation process outcomes across the three sites, guided by the Medical Research Council framework for complex intervention process evaluations. Data were collected through observations of peer support group meetings using a structured guide, and semistructured interviews with project managers, implementers, and participants. RESULTS The countries aligned implementation in accordance with the feasibility and relevance in the local context. In Uganda and Sweden, the implementation focused on peer support; in South Africa, it focused on the care companion part. The community-facility link received the least attention. Continuous capacity building received a lot of attention, but intervention reach, dose delivered, and fidelity varied substantially. Intervention-related and context-related barriers affected participation. CONCLUSIONS Identification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and flexibility in evaluation design to adapt to the complex nature of the intervention. When designing interventions, it is crucial to consider aspects of the implementing organization or structure, its absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale-up of complex interventions. TRIAL REGISTRATION NUMBER ISRCTN11913581.
Collapse
Affiliation(s)
- Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Pilvikki Absetz
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Timm
- Department of Global Health, Karolinska Institute, Stockholm, Sweden
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Rondebosch, Western Cape, South Africa
- Mental Health & Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Glorai Naggayi
- School of Public Health, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Francis Kasujja
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mariam Hassen
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jeroen de Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | | | - Thandi Puoane
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes-Göran Östenson
- Department of Global Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Goran Tomson
- Department of Global Health, Centrum för arbets- och miljömedicin, Stockholm, Sweden
| | - David Guwatudde
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Uppsala Universitet, Uppsala, Sweden
| |
Collapse
|
9
|
Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Mølsted Alvesson H. Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes. Nutrients 2021; 13:nu13113862. [PMID: 34836116 PMCID: PMC8618573 DOI: 10.3390/nu13113862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants’ needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.
Collapse
Affiliation(s)
- Linda Timm
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Correspondence:
| | - Ida Karlsson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | | | - Birger C. Forsberg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
- International Maternal and Child Health Division, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 751 22 Uppsala, Sweden
| | - Helle Mølsted Alvesson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (I.K.); (K.S.A.); (B.C.F.); (M.D.); (H.M.A.)
| |
Collapse
|
10
|
Jalkanen K, Järvenpää R, Tilles-Tirkkonen T, Martikainen J, Aarnio E, Männikkö R, Rantala E, Karhunen L, Kolehmainen M, Harjumaa M, Poutanen K, Ermes M, Absetz P, Schwab U, Lakka T, Pihlajamäki J, Lindström J. Comparison of Communication Channels for Large-Scale Type 2 Diabetes Risk Screening and Intervention Recruitment: Empirical Study. JMIR Diabetes 2021; 6:e21356. [PMID: 34499036 PMCID: PMC8461532 DOI: 10.2196/21356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/26/2020] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention. Objective This study aims to compare the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire, with emphasis on reaching those at most risk. The participants expressing their willingness to participate is the final step in the risk screening test, and we aim to determine which channels had the most participants reach this step. Methods We established a stepwise web-based T2D risk screening tool with automated feedback according to the T2D risk level and, for those who were eligible, an invitation to participate in the StopDia prevention intervention study conducted in a primary health care setting. The risk estimate was based on the Finnish Diabetes Risk Score; history of repeatedly measured high blood glucose concentration; or, among women, previous gestational diabetes. We used several channels to invite people to the StopDia web-based screening tool, and respondents were classified into 11 categories based on the channel through which they reported having learned about StopDia. The demographics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through risk screening steps. Results A total of 33,399 persons started filling the StopDia screening tool. Of these, 86.13% (28,768/33,399) completed the test and named at least one communication channel as the source of information about StopDia. Altogether, 26,167 persons filled in sufficient information to obtain risk estimates. Of them, 53.22% (13,925/26,167) were at increased risk, 30.06% (7866/26,167) were men, and 39.77% (10,136/25,485) had low or middle education levels. Most frequently mentioned channels were workplace (n=6817), social media or the internet (n=6712), and newspapers (n=4784). The proportion of individuals at increased risk was highest among those reached via community pharmacies (415/608, 68.3%) and health care (1631/2535, 64.33%). The communication channel reaching the largest percentage of interested and eligible men (1353/3979, 34%) was relatives or friends. Health care (578/1069, 54.07%) and radio or television (225/487, 46.2%) accounted for the largest proportion of people with lower education. Conclusions Communication channels reaching a large number of people, such as social media and newspapers, were the most effective channels for identifying at-risk people. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with a particularly high T2D risk. Thus, communication and recruitment channels should be selected and modified based on the intended target group. International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-6574-y
Collapse
Affiliation(s)
- Kari Jalkanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riia Järvenpää
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Janne Martikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Emma Aarnio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Eeva Rantala
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Leila Karhunen
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Marjukka Kolehmainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Timo Lakka
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | |
Collapse
|
11
|
Elinder LS, Wiklund CA, Norman Å, Stattin NS, Andermo S, Patterson E, Hemmingsson E, Cook C, Raposo S, Kwak L. IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial. BMC Public Health 2021; 21:1630. [PMID: 34488691 PMCID: PMC8419825 DOI: 10.1186/s12889-021-11663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5–7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents’ risk of developing type 2 diabetes. Methods IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents’ feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability. Discussion This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools. Trial registration Registered prospectively at ClinicalTrials.gov ID: NCT04984421, registered July 30, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11663-2.
Collapse
Affiliation(s)
- Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden.
| | - Camilla A Wiklund
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Clinical Neurosciences, Karolinska Institutet, SE-171 65, Solna, Sweden
| | - Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Region Stockholm, SE-113 65, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Susanne Andermo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Erik Hemmingsson
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, SE-114 68, Stockholm, Sweden
| | - Clayton Cook
- Department of Organizational Leadership and Policy Development, University of Minnesota, Minneapolis, MN, 55, USA
| | - Sara Raposo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden
| | - Lydia Kwak
- Institute for Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| |
Collapse
|