Abstract
BackgroundType 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes.ObjectiveThe objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes.MethodsSemistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program.ResultsA separate paper describes the protocol for a randomized controlled trial to provide this required evaluation.ConclusionsDevelopment of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users’ experiences and examining the program’s effectiveness and cost-effectiveness in randomized controlled trials.Trial RegistrationThe Australian New Zealand Clinical Trials Registry (ACTRN): 12614001126606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001126606 (Archived by WebCite at http://www.webcitation.org/6U0Fh3vOj).
Highlights
Type 2 Diabetes Self-ManagementType 2 diabetes is a burgeoning epidemic that affects an estimated 347 million people worldwide [1], and is becoming one of the leading causes of global disease burden [1]
This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes
Inadequate diabetes self-care is strongly associated with poor glycaemic control [2,3], which increases the risk of diabetes complications including peripheral limb amputation, blindness, and end-stage renal disease [1], as well as cardiovascular disease and stroke [4]
Summary
Users can plan to add incidental and short bursts of activity to their week, as well as longer physical activity sessions, and specify the times and days that they will do them It includes a problem-solving tool [61] to assist with overcoming challenges to reaching users’ personalized goals. Users are asked to focus on practicing the skills learned in each section for 1-2 weeks before moving forward in the program In the meantime they are encouraged to log on to the site regularly to self-monitor, use resources, undertake, and revisit tools as needed. Guidebook pages throughout the program refer users to the most relevant mindfulness resources to each area Inclusion of these resources is based on evidence regarding the deleterious effects of stress on glycaemic control and its tendency to increase susceptibility to dysphoria and diabetes-specific distress. Brief videos that feature role models on key health-related and behavior change areas (eg, alcohol modification, physical activity) are included, and provide vicarious experience
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