Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
Highlights
Diabetes is a chronic disease that requires daily decision making and self-care by the patients
Of the 33 providers, 13 stated that they had fully adhered to the program protocol, while another 13 reported to have made at least one adaptation (10 reported changes in the content, 5 changed the duration, 9 adapted the frequency and 7 changed the coverage)
The results show that more than a third of the providers of diabetes self-management programs reported to have fully adhered to the intervention protocol
Summary
Diabetes is a chronic disease that requires daily decision making and self-care by the patients. Due to this need to self-manage the disease, a patient’s capacity to manage his or her disease is considered a key determinant of treatment outcomes and related costs [1]. DSME is broadly defined as the process of facilitating the knowledge, skill and ability that are required for diabetes self-care. An additional factor that is sometimes mentioned as a determinant of DSME effectiveness is the way the program is implemented. Implementation remains a peripheral issue in the literature on DSME, and there is a clear lack of research about the implementation fidelity of existing programs
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