Abstract

BackgroundThe purpose of this study was to explore the barriers and facilitators healthcare professionals experience when managing type 2 diabetes in people with severe mental illness (SMI).MethodsA qualitative semi-structured interview approach was employed. Questions were structured according to the Theoretical Domains Framework (TDF), which outlines 14 domains that can act as barriers and facilitators to changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains of the TDF, belief statements were created within each domain and the most relevant belief statements within each domain identified through a consensus approach. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher.ResultsSixteen healthcare professionals, from a range of services, involved in the care of people with type 2 diabetes and SMI took part in an interview. Inter-rater reliability for each of the domains varied (25 %-74 %). All fourteen domains were deemed relevant, with 42 specific beliefs identified as important to the target behaviour. Participants identified having relevant knowledge and skills for diabetes management, prioritising this area of health, and reviewing health behaviours to develop action plans, as particularly important. At an organisational level, integrated care provision and shared information technology (IT) services between mental health and physical services, and clearly defined roles and responsibilities for the different professions, with designated time to undertake the work were identified as crucial.ConclusionsThe findings highlight that healthcare professionals’ experience a range of barriers and enablers when attempting to manage type 2 diabetes in people with SMI. These include organisational factors and individual beliefs, suggesting that interventions need to be targeted at both an organisation and individual level in order to change behaviour. Further work is needed to model these relationships in a larger sample of participants in line with the MRC guidance for developing complex interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0942-2) contains supplementary material, which is available to authorized users.

Highlights

  • The purpose of this study was to explore the barriers and facilitators healthcare professionals experience when managing type 2 diabetes in people with severe mental illness (SMI)

  • We initially identified 2 key healthcare professionals involved in caring for people with type 2 diabetes and SMI; these participants were asked to identify two individuals who they believe would provide useful information, and so on until the full sample were recruited

  • In using the Theoretical Domains Framework (TDF) [25], our study has provided a comprehensive understanding of the enablers and barriers to delivering effective care for type 2 diabetes in people with SMI, from the perspective of various healthcare providers

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Summary

Introduction

The purpose of this study was to explore the barriers and facilitators healthcare professionals experience when managing type 2 diabetes in people with severe mental illness (SMI). In the UK, 6.2 % of the adult population are estimated to have diabetes and as in other high income countries around 90 % of have type 2 diabetes [1]. Research indicates a 2–3 fold increased incidence of type 2 diabetes among people with SMI [2]. This increased risk has been attributed to a number of factors, including the effects of antipsychotic medications [3], lifestyle factors such as poor diet, obesity and physical inactivity [2, 4] and high rates of smoking [5]. In people diagnosed with diabetes, those with SMI have been found to die significantly younger than people without SMI [6] and experience a greater risk of diabetes complications that require specialist treatment [7]

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