Abstract
It is estimated among individuals with type 2 diabetes (T2D) requiring injectable therapies to achieve optimal glycaemic control, one-third are reluctant to initiate therapies, with approximately 80% choosing to discontinue or interrupt injectable regimens soon after commencement. Initiation of injectables is a complex issue, with effectiveness of such treatments undermined by non-adherence or poor engagement. Poor engagement and adherence are attributed to psychological aspects such as individuals' negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control over their condition. The aim of this study was to describe the development of a structured diabetes intervention to address psychological barriers to injectable treatments among a cohort of those with T2D; conducted within a behavioural change framework. An evidence base was developed to inform on key psychological barriers to injectable therapies. A systematic review highlighted the need for theory-based, structured diabetes education focussed on associated psychological constructs to inform effective, patient-centric provisions to improve injectable initiation and persistence. Findings from the focus groups with individuals who had recently commenced injectable therapies, identified patient-centric barriers to initiation and persistence with injectables. Findings from the systematic review and focus groups were translated via Behavioural Change Wheel (BCW) framework to develop an intervention for people with T2D transitioning to injectable therapies: Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This article describes how psychological barriers informed the intervention with these mapped onto relevant components, intervention functions and selected behaviour change techniques, and finally aligned with behaviour change techniques. This article outlines the systematic approach to intervention development within the BCW framework; guiding readers through the practical application of each stage. The use of the BCW framework has ensured the development of the intervention is theory driven, with the research able to be evaluated and validated through replication due to the clarity around processes and tasks completed at each stage.
Highlights
The complexities of treatment regimens for those living with Type 2 Diabetes (T2D) can be problematic, contributing to issues with medication adherence among this population [1]
The identified barriers have been used to inform the intervention, within the Behavioural Change Wheel (BCW) Framework, with these mapped onto the relevant COM-B components, intervention functions and selected behavioural change techniques (Table 1)
The systematic process within the BCW framework provides a clear pathway for intervention design
Summary
The complexities of treatment regimens for those living with Type 2 Diabetes (T2D) can be problematic, contributing to issues with medication adherence among this population [1] This is salient among those who require the use of injectable therapy i.e. GLP-1 receptor agonists or insulin, to achieve optimal glycaemic control [2]. Poor injectable uptake and adherence have been attributed to “significant barriers in the minds of patients” [(6), s12] Psychological aspects such as individuals’ perceptions of injectables, depression, anxiety, fear of injections, perceived pain, feelings of shame and failure can impact on engagement with therapies of this type [7,8,9]. These psychological aspects are associated with poorer: clinical outcomes, initiation of injectable therapies, medication adherence and motivation which impact negatively on effective self-management behaviours [9,10,11,12,13]
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