1
|
Munch L, Stensgaard S, Feinberg MB, Elwyn G, Lomborg K. Evaluating the effect of Conversation Cards on agenda-setting in annual diabetes status visits: A multi-method study. PATIENT EDUCATION AND COUNSELING 2024; 119:108084. [PMID: 38029577 DOI: 10.1016/j.pec.2023.108084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate Conversation Cards for shared agenda-setting between patients and nurses in status visits for type 2 diabetes. METHODS Non-randomized comparison of survey responses between intervention and control groups. Content analysis of interview data of patient experiences from a purposive sample of the intervention group. RESULTS The survey included 52 patients in the intervention and 55 in the control group. Survey data showed no significant differences between the groups. Regardless of the intervention, patients experienced that topics relevant to them were addressed. One in four patients rated the Conversation Cards as very supportive. Interview data indicated that the Conversation Cards added structure, commitment to the conversation, and support to raise topics not previously considered diabetes related. CONCLUSION Topics of concern were addressed in both intervention and control groups. The Conversation Cards for agenda-setting clarified a mutually agreed structure of the conversation, eased raising hitherto ignored topics, and increased engagement. PRACTICE IMPLICATIONS The Conversation Cards have potential to improve shared agenda-setting, but implementation requires efforts from both parties. Patients are expected to consider their concerns and take an active part in agenda-setting. Nurses are expected to collaborate with the patient in the agenda-setting, which might challenge the nurses' habitual practice.
Collapse
Affiliation(s)
- Lene Munch
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark.
| | - Sebrina Stensgaard
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Mie Buron Feinberg
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kirsten Lomborg
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Wang R, Rouleau G, Booth GL, Brazeau AS, El-Dassouki N, Taylor M, Cafazzo JA, Greenberg M, Nakhla M, Shulman R, Desveaux L. Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation. JMIR Res Protoc 2023; 12:e46115. [PMID: 37703070 PMCID: PMC10534286 DOI: 10.2196/46115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Emerging adults living with type 1 diabetes (T1D) face a series of challenges with self-management and decreased health system engagement, leading to an increased risk of acute complications and hospital admissions. Effective and scalable strategies are needed to support this population to transfer seamlessly from pediatric to adult care with sufficient self-management capability. While digital health interventions for T1D self-management are a promising strategy, it remains unclear which elements work, how, and for which groups of individuals. OBJECTIVE This study aims to evaluate the design and implementation of a multicomponent SMS text message-based digital health intervention to support emerging adults living with T1D in real-world settings. The objectives are to identify the intervention components and associated mechanisms that support user engagement and T1D health care transition experiences and determine the individual characteristics that influence the implementation process. METHODS We used a realist evaluation embedded alongside a randomized controlled trial, which uses a sequential mixed methods design to analyze data from multiple sources, including intervention usage data, patient-reported outcomes, and realist interviews. In step 1, we conducted a document analysis to develop a program theory that outlines the hypothesized relationships among "individual-level contextual factors, intervention components and features, mechanisms, and outcomes," with special attention paid to user engagement. Among them, intervention components and features depict 10 core characteristics such as transition support information, problem-solving information, and real-time interactivity. The proximal outcomes of interest include user engagement, self-efficacy, and negative emotions, whereas the distal outcomes of interest include transition readiness, self-blood glucose monitoring behaviors, and blood glucose. In step 2, we plan to conduct semistructured realist interviews with the randomized controlled trial's intervention-arm participants to test the hypothesized "context-intervention-mechanism-outcome" configurations. In step 3, we plan to triangulate all sources of data using a coincidence analysis to identify the necessary combinations of factors that determine whether and how the desired outcomes are achieved and use these insights to consolidate the program theory. RESULTS For step 1 analysis, we have developed the initial program theory and the corresponding data collection plan. For step 2 analysis, participant enrollment for the randomized controlled trial started in January 2023. Participant enrollment for this realist evaluation was anticipated to start in July 2023 and continue until we reached thematic saturation or achieved informational power. CONCLUSIONS Beyond contributing to knowledge on the multiple pathways that lead to successful engagement with a digital health intervention as well as target outcomes in T1D care transitions, embedding the realist evaluation alongside the trial may inform real-time intervention refinement to improve user engagement and transition experiences. The knowledge gained from this study may inform the design, implementation, and evaluation of future digital health interventions that aim to improve transition experiences. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46115.
Collapse
Affiliation(s)
- Ruoxi Wang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Geneviève Rouleau
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Département des Sciences Infirmières, Université du Québec en Outaouais, St-Jérôme, QC, Canada
- Faculté des sciences infirmières, l'Université de Montréal, Montreal, QC, Canada
| | - Gillian Lynn Booth
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Noor El-Dassouki
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Madison Taylor
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Marley Greenberg
- Department of Philosophy, Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
- Diabetes Action Canada, Toronto, ON, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Rayzel Shulman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Morrissey EC, Dinneen SF, Lowry M, de Koning EJP, Kunneman M. Reimagining care for young adults living with type 1 diabetes. J Diabetes Investig 2022; 13:1294-1299. [PMID: 35511075 PMCID: PMC9340877 DOI: 10.1111/jdi.13824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Young adults living with type 1 diabetes often struggle to achieve what clinicians consider to be optimal levels of metabolic control. Despite the impact that this can have on a young person's future risk of complications, there are relatively few studies reporting new ways of organizing or delivering care to this cohort. In this article, we explore some of the reasons why young adult diabetes care is challenging, and describe approaches to “re‐imagining” how care might be improved. The work is informed by the ‘Making Care Fit’ collaborative and by a program of research, entitled D1 Now, involving co‐design of a complex person‐centered intervention with young adults.
Collapse
Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland.,Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Ireland
| | - Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|