Initial evaluation of the Optimal Health Program for people with diabetes: 12-month outcomes of a randomised controlled trial

OBJECTIVE

This study aimed to evaluate if a new Mental health IN DiabeteS Optimal Health Program (MINDS OHP) compared with usual care in adults with Type 1 and Type 2 diabetes would improve psychosocial outcomes including self-efficacy and quality of life.Design and Main Outcome Measures This initial randomised controlled trial evaluated MINDS OHP compared with usual care. Participants were recruited through outpatient clinics and community organisations. The intervention group received nine sessions with assessments over twelve months. Primary outcomes were self-efficacy and quality of life. Secondary outcomes included diabetes distress and anxiety.

RESULTS

There were 51 participants in the control group (mean age = 52) and 55 in the intervention group (mean age = 55). There were significant main effects of time in general self-efficacy, diabetes distress, diabetes self-efficacy, and illness perceptions, however no significant between-group differences in primary or secondary outcomes. Post-hoc analyses revealed MINDS OHP improved diabetes self-efficacy for participants with mild to severe depression and anxiety, with a small effect.

CONCLUSION

Initial evaluation found MINDS OHP was associated with improved diabetes self-efficacy for adults with diabetes, for people with mild to severe levels of distress, with small effect. Further research is required to explore whether this disease-specific, collaborative care-focused intervention benefits the mental health of people with diabetes.

Defining Life Skills in health promotion at school: a scoping review

Background

Life Skills have been central to Health Promotion interventions and programmes with children and adolescents for over 40 years. School is a strategic setting for Life Skills education. Recently, policy-and decision-makers have focused on Life Skills development for youth. Research on Life Skills has gained momentum. Different terms are used to discuss and define Life Skills. Research identifies a lack of conceptual definition. The purpose of this study is to identify the definitions in the literature in English and French, and to reach a conceptual and consensual definition.

Method

The Scoping Review methodology was used. Three research questions aim to identify how Life Skills are defined in the field of health promotion at school, to see whether a conceptual and consensual definition exists, and, if relevant, to propose a conceptual definition. The search was conducted in 5 databases by 3 reviewers. This study focused on full-text publications in English or French, human studies, health promotion in school, school pupils, teacher training, and with a definition of Life Skills. Publications on after-school activities, higher education outside teacher training, adult education, other than peer-reviewed scientific papers were excluded.

Results

48 publications were included in English and 7 in French. NVIVO was used to determine and compare the French and English terms used for Life Skills and their definitions. According to the three research questions, (i) the terms used to define Life Skills are diverse and numerous, with different purposes at school in relation to health promotion, and different taxonomies, and relate to different areas of research; (ii) no consensual, conceptual definition of Life Skills was found; (iii) further semantic, epistemological and ontological clarifications are required.

Conclusion

Some conceptual definitions of Life Skills exist without consensus. Life Skills being at the crossroads between different fields could explain this and is illustrated by the multiplicity and diversity of the terms employed, and the various taxonomies and purposes used at school in health promotion. This may also explain why they are difficult to evaluate. Defining Life Skills consensually cannot be achieved due to the diversity of research perspectives from different fields.

First use of Simulation in Therapeutic Patient Education (S-TPE) in adults with diabetes: a pilot study

OBJECTIVE

To pilot test the feasibility and acceptability of Simulation in Therapeutic Patient Education (S-TPE), in both adult patients with diabetes and educators.

CONCEPTION

Adult patients with insulin-dependent diabetes and who participated in a full TPE programme for the implementation of a FreeStyle were included in this monocentric pilot study. S-TPE intervention was based on a consensus conference determining the conditions and objectives of S-TPE. Main outcomes were the patients' and educators' perception of the usefulness of S-TPE and the patient's satisfaction level at the conclusion of the simulation sequence, measured on validated scales. Secondary outcomes were organisational, human, material and temporal, facilitating and limiting factors for patients and educators, patient self-efficacy and anxiety scores.

INTERVENTIONS

The final session of TPE used the simulation. For each group, one patient volunteered to be the simulated patient. Intervention was divided into three steps: (1) a pre-briefing, (2) a simulation of hypoglycaemia and (3) a debriefing with the group of patients and educators. The whole intervention lasted about 2 hours.

RESULTS

We included 23 patients (mean age ±SD 63±15 years, 14 men) and 3 educators. After S-TPE intervention, patients' and educators' perceived usefulness score were 20.6/25 and 37.5/40, respectively. Patient's satisfaction score was 51.9/60. Qualitative analysis revealed no limiting factors to implementing S-TPE. Self-efficacy was stable. Decrease in anxiety score after S-TPE reached statistical significance in women (from 35.1±4.5 to 32.7±5.5, p=0.04) but not in men.

CONCLUSION

No limiting factors that could prevent the conduct of clinical trials to assess S-TPE efficacy in patients with diabetes were identified. S-TPE appears as a promising technique to improve diabetes management.

TRIAL REGISTRATION NUMBER

Registration N°: 2019-A00773-54 and NTC: 03956927.

Representações sociais e educação terapêutica: questões teórico-práticas

Resumo Apresentamos a contribuição da psicologia social da saúde por meio da abordagem sociorrepresentacional para refletir acerca da educação terapêutica do(a) adolescente com diabetes mellitus tipo 1. O adoecimento crônico na adolescência coloca desafios específicos para o cuidado, o olhar psicossocial permite compreender a prática de avaliação e o fortalecimento das habilidades do paciente contextualizando a educação terapêutica enquanto conjunto de relações sociossimbólicas entre os atores da situação. Essa abordagem pode servir como uma ferramenta teórico-metodológica e prática para alcançar um diagnóstico psicossocial e um planejamento de intervenção. Um programa de três pesquisas realizadas na França com adolescentes diabéticos, suas famílias e profissionais ilustra questões e desafios contemporâneos no campo da educação terapêutica, centrando sua análise nos significados que os atores mobilizam para, assim, determinar estratégias de intervenção adaptadas às tensões psicossociais que possam surgir no cuidado. Ressaltamos a importância das dinâmicas socioidentitária e ideológica advindas do contexto social e cultural de referência dos atores engajados na educação terapêutica.

'Adolescents are reckless': Representations at stake in the construction of the relationship of trust in paediatric diabetology

A total of 10 focus groups were held with adolescents living with diabetes, their parents and health professionals in order to explore their needs in therapeutic education. The analysis showed that the relationship of trust was a central concern for a number of participants. Several adults were divided between a feeling of confidence inspired by the need to empower adolescents to cope with the chronic condition and a sense of distrust inspired by the idea of carelessness and irresponsibility thought to characterize adolescence. Adolescents, for their part, seemed relatively clear-sighted about how they can be perceived, and blamed adults for not trusting them. These findings emphasize the importance of considering the representations at stake in the dynamics of the therapeutic relationship in order to better understand the construction of the relational climate.

Efficacy of Self-hypnosis on Quality of Life For Children with Chronic Pain Syndrome

The aim of this study was to assess the efficacy of self-hypnosis in a therapeutic education program (TEP) for the management of chronic pain in 26 children aged 7 to 17 years. Outcomes of the study were a total or a partial (at least 1) achievement of the therapeutic goals (pain, quality of sleeping, schooling, and functional activity). Sixteen patients decreased their pain intensity, 10 reached all of their therapeutic goals, and 9 reached them partially. Self-hypnosis was the only component of the TEP associated with these improvements. The current study supports the efficacy of self-hypnosis in our TEP program for chronic pain management in children.

Representations and experiences of well-being among diabetic adolescents: Relational, normative, and identity tensions in diabetes self-management

We explore representations of well-being in adolescents with Type 1 diabetes in order to better understand their expectations and needs in therapeutic patient education. In total, 28 interviews were performed and then submitted to thematic content analysis and lexicometric analysis. Results show the intervention of psychosocial processes in the relationship that adolescents maintain with well-being and self-management. More specifically, we observed that well-being is impacted by areas of tension between the expectations of adolescents and the therapeutic objectives expressed by health professionals. These tensions should be taken into account in the conception, implementation, and evaluation of therapeutic education programs.

French healthcare professionals' perceived barriers to and motivation for therapeutic patient education: A qualitative study

Therapeutic patient education is effective for various patient outcomes; however, healthcare professionals sometimes lack the motivation to carry out patient education. Surprisingly, this issue has rarely been addressed in research. Therefore, this study explores healthcare professionals' perceived barriers to and motivation for therapeutic patient education. Healthcare professionals, mainly nurses, working in different French hospitals were interviewed. Thematic content analysis was performed. Findings included a lack of skills, knowledge, and disillusionment of the effectiveness of therapeutic patient education were features of a demotivated attitude. In contrast, a positive attitude was observed when therapeutic patient education met a need to work differently and more effectively. A key factor motivating professionals was the integration of therapeutic patient education in routine care within a multidisciplinary team. To keep healthcare professionals motivated, managers should ensure that therapeutic patient education is implemented in accordance with its core principles: a patient-centered approach within a trained multidisciplinary team. In the latter case, therapeutic patient education is viewed as an efficient and rewarding way to work with patients, which significantly motivates healthcare professionals.

The Mental Health in Diabetes Service (MINDS) to enhance psychosocial health: study protocol for a randomized controlled trial

Background

After a diagnosis of diabetes mellitus, people not only have to cope with the physical aspects and common complications that require daily self-management, they are also faced with ongoing psychosocial challenges. Subsequently they find themselves having to navigate the health system to engage multidisciplinary supports; the combination of these factors often resulting in reduced health-related quality of life. To maintain optimal diabetes control, interventions need to incorporate psychosocial supports and a skill base for disease management. Therefore, our aim was to evaluate an ‘Optimal Health Program’ that adopts a person-centred approach and engages collaborative therapy to educate and support the psychosocial health of people diagnosed with type I or II diabetes.

Methods

This prospective randomised controlled trial will include 166 people diagnosed with diabetes: 83 in the intervention (Optimal Health Program) and 83 in the control (usual care) group. Participants with type diabetes mellitus will be recruited through hospital outpatient clinics and diabetes community organisations. Participants in the intervention group will receive nine (8 + 1 booster session) sequential sessions, based on a structured treatment manual emphasising educational and psychosocial support self-efficacy and skills building. The primary outcome measures will be generalised self-efficacy (GSE) and health-related quality of life (AQoL-6D and EQ-5D). Secondary measures will be anxiety and depression (HADS), social and workplace functioning (WSAS), diabetes-related quality of life (DQoL), diabetes-related distress (PAID), and type of coping strategies (Brief COPE). In addition, a health economic cost analysis and process evaluations will be performed to assess the economic cost and efficacy of the program’s operations, implementation and service delivery.

Discussion

We envisage that the Optimal Health Program’s emphasis on self-efficacy and self-management will provide participants with the skills and knowledge to achieve increased empowerment and independence in aspects of health, which in turn, will help participants deal more effectively with the physical and psychosocial complexities of diabetes.

Trial registration

ACTRN12614001085662. Registered on 10 October 2014.