Diabetes Education And Self Management For Ongoing And Newly Diagnosed Research Articles

Understanding how self-management education and support programmes for type 2 diabetes are expected to change behaviour: A document analysis of two programmes.

Attendance at diabetes self-management education and support (DSMES) programmes for type 2 diabetes is associated with positive outcomes, but the impact on some outcomes is inconsistent and tends to decline over time. Understanding the active ingredients of effective programmes is essential to optimise their effectiveness. This study aimed to (1) retrospectively identify behaviour change techniques (BCTs), mechanisms of action (MoAs) and intervention functions in two DSMES programmes, the Community-Oriented Diabetes Education and the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed and (2) examine variation in content between programmes. A multiple case study approach, including a documentary analysis of the programme materials, was conducted. Materials were coded using the BCT Taxonomy v1, the Mode of Delivery Ontology v1 and the Intervention Source Ontology v1. The Behaviour Change Wheel guidance and the Theory and Techniques tool were used to identify intervention functions and MoAs. Programme stakeholders provided feedback on the findings. Thirty-four BCTs were identified across the programmes, with 22 common to both. The identified BCTs were frequently related to 'goals and planning', 'feedback and monitoring' and 'natural consequences'. BCTs were linked with 15 MoAs, predominantly related to reflective motivation ('beliefs about capabilities' and 'beliefs about consequences') and psychological capability ('knowledge'). BCTs served six intervention functions, most frequently 'education', 'enablement' and 'persuasion'. Although both programmes included several BCTs, some BCTs were rarely or never used. Additional BCTs could be considered to potentially enhance effectiveness by addressing a wider range of barriers.

Increasing patient activation through diabetes self-management education: Outcomes of DESMOND in regional Western Australia

ObjectiveTo evaluate the effects of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) program on patient activation in adults living with type 2 diabetes (T2D). Methods233 individuals attended a DESMOND program in 26 locations across regional Western Australia. Individuals completed the Patient Activation Measure (PAM) prior to and immediately after DESMOND participation. ResultsPatient Activation significantly increased by 9.7 points from pre to post DESMOND intervention (p < 0.001, z = −7.94). Of all participants who exhibited an increase in patient activation, 87% (n = 142) experienced a clinically significant (>5 point) increase. Post-DESMOND participation, an 86% reduction (from 6% −0.9%) in the proportion of participants scoring in the lowest PAM level (Level 1) was observed (p < 0.01). ConclusionDESMOND, a structured diabetes self-management education (DSME) program aimed at strengthening the role of people living with type 2 diabetes in self-managing their healthcare, significantly increased patient activation in a real-world setting. Practice implicationsIn line with international diabetes guidelines it is recommended that people living with T2D, particularly those with lower levels of activation, attend an evidence based DSME such as DESMOND to increase their capacity to effectively self-manage their condition.

Assessing the effectiveness of a goal-setting session as part of a structured group self-management education programme for people with type 2 diabetes

ObjectivesTo measure the number of people who have identified a behaviour change goal and completed an action-plan to meet their goal on completion of a diabetes self-management education programme (DSME) and level of success in sustaining their action-plan. The DSME people attended was Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). MethodsCopies of action-plans were collected from participants. Postal questionnaires were sent to participants one week and three months following DESMOND to assess factors associated with setting and sustaining action-plans. Results92% (253/275) of participants completed an action-plan. Reducing weight was the area most targeted. Physical activity was the most common goal. 68% (187/275) returned a three month questionnaire. 96% indicated they were still working on their action plan, with 87% reporting they were always/usually meeting their action-plan. 22% said they had discussed their goal with a health care professional (HCP) following DESMOND. ConclusionsGoal-setting as part of a DSME can lead to behaviour change. Practice implicationsGoal-setting as part of a DSME enables participants to set and attain behaviour change goals. Informing HCPs of a person's action-plan following a DSME may further support a person undertaking behaviour change.

Real‐world evaluation of the DESMOND type 2 diabetes education and self‐management programme

AbstractDiabetes education and self‐management programmes are associated with improved biomedical, psychosocial and behavioural outcomes according to a number of randomised controlled trials (RCT) and systematic reviews. Observational studies are necessary to determine whether delivery of this education translates to improved outcomes in the real world. In 2008, the results of an RCT evaluating Diabetes Education and Self‐Management for Ongoing and Newly Diagnosed (DESMOND) in a multi‐ethnic population were published confirming the benefits of participating in this programme with sustained improvements at three years along with confirmed cost‐effectiveness. DESMOND has therefore been recommended by NICE as a robust and validated national diabetes structured education programme.DESMOND courses have been offered by the Leicester City, Leicestershire and Rutland (LLR) clinical commissioning groups for people newly diagnosed or with pre‐existing type 2 diabetes since 2008, and we reviewed the outcomes of participants who attended a course between January 2014 and March 2015. During this period, 1678 (53%) participants attended one of 244 courses in LLR compared with 5.3% attending any validated structured education programme nationally. Notably, there was a statistically significant reduction in HbA1c of 0.96% at six months and 0.70% at 12 months (both p &lt; 0.005). Qualitative evaluation from surveys completed by 302/1678 (18%) respondents immediately after attending DESMOND found that the programme was well received by participants who noted improvements in their ability to self‐manage diabetes.This 15‐month evaluation of DESMOND confirms the benefits of attending the programme in the real world. Copyright © 2018 John Wiley &amp; Sons.

Introduction of the DESMOND Programme for Type Two Diabetes to WellSouth Primary Health Network

Introduction : In order to manage the increasing numbers of people with type two diabetes mellitus (T2DM) in New Zealand, supporting self-management is crucial. There are many education programmes running in New Zealand for patients with T2DM. However these courses have limited evidence against which to benchmark results or give guidance as to their effectiveness. When designing a service to meet the needs of people with T2DM in the Southern Region, WellSouth looked to implement a programme that was evidence based and based on sound theories. The DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) Foundation Programme met this criteria. Practice change implemented : To ensure continuity of information provided to patients closer to home, WellSouth established an accessible self-management education day for people living with T2DM. Aim and theory of change : The aim of introducing DESMOND was to encourage people living with T2DM to take ownership, and have better self-management of their condition. DESMOND focuses on the lived experience of the person with diabetes, and the day starts with discussing their beliefs about their diabetes. The DESMOND theory is that only the person can change their own beliefs and the DESMOND educators help to facilitate this throughout the day. Targeted population and stakeholder : The programme was developed for people with newly diagnosed T2DM but has adaptions for those who have been diagnosed longer. DESMOND is delivered in a number of centres across the Southern Region, to meet the needs of a geographically spread population. WellSouth invested a large amount in training a multi-disciplinary team of nurses, pharmacists and dietitians to be DESMOND educators. This investment should be returned by improving the health of the T2DM population. Timeline : The programme was introduced eighteen months ago, in that time thirteen educators have been trained and 300 participants have attended DESMOND throughout the region. Highlights : When the programme was developed, it was done using health professionals and people living with diabetes. The structured nature and rigorous quality development process of DESMOND means that it is delivered the same every time. Evaluation results six months post-programme in Australia and the UK have shown: - A significant decrease in systolic blood pressure - A significant decrease in ‘diabetes distress’ - A trend toward reduction in cholesterol and HbA1c - A significant increase in physical activity - A significant increase in perceived impact of diabetes. Sustainability : Due to the structured evaluation of the programme, there is stringent data to back up the effectiveness of DESMOND. The positive results will help in the continued financial backing and there is also the possibility of the WellSouth educators going onto train other organisations in the country to deliver DESMOND in the future. Transferability : DESMOND was originally developed in the UK before going to Australia and New Zealand. This shows how easily the programme can be transferred with a few minor changes (cultural, ethnicity) to work in different geographical areas. Conclusion : DESMOND has provided a unique tool to give people with T2DM the skills to optimally self-manage their condition.

Explaining engagement in self-monitoring among participants of the DESMOND Self-monitoring Trial: a qualitative interview study.

The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and randomized to self-monitoring of blood glucose (SMBG) or urine monitoring had comparable improvements in biomedical outcomes, but differences in satisfaction with, and continued use of monitoring method, well-being and perceived threat from diabetes. To explore experiences of SMBG and urine monitoring following structured education. We specifically addressed the perceived usefulness of each monitoring method and the associated well-being. Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial (SMBG, N=10; urine monitoring, N=8)~12 months into the trial. Analysis was informed by the constant comparative approach. Interviewees reported SMBG as accurate, convenient and useful. Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals. Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy, leading some to switch to SMBG. Perceiving diabetes as less serious was attributable to lack of symptoms, treatment with diet alone and-in the urine-monitoring group-consistently negative readings. Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose. The findings highlight the importance for professionals of considering patients' preferences when using self-monitoring technologies, including how these change over time, when supporting the self-care behaviours of people with type 2 diabetes.

"And now for the good news..." the impact of negative and positive messages in self-management education for people with Type 2 diabetes: A qualitative study in an ethnically diverse population.

To explore the impact of Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) Foundation education, particularly from interviewees' narratives regarding recall of good and bad news messages and behaviour changes. In-depth, semi-structured interviews were conducted with a purposive sample (n=19) of people who had attended education sessions as part of a randomised controlled trial in two UK sites with ethnically diverse populations. Data collection and analysis were informed by the constant comparative approach and facilitated through charting. Findings were similar in people from different ethnic backgrounds. Exploration of levels of recall of the sessions suggested that this was variable and sometimes very limited, but that interviewees had all assimilated some relevant learning. Key themes emerged relating to the way in which interviewees recalled and had been influenced by positive (good news) and negative (bad news) messages within the education sessions, including biomedical explanations. Both types of message appeared to have an important role in terms of motivation to change behaviour, but a notable observation was that none of the interviewees recalled receiving bad news messages when diagnosed. Our findings have highlighted the importance of providing and combining both negative and positive messages within education designed to promote self-management behaviour change.

The impact of the NSF for Diabetes on patient empowerment

The National Service Framework (NSF) for Diabetes was developed by the UK government to tackle variations in care for patients with diabetes. This article critically analyses the impact of this policy and its effect on health care, focusing specifically on Standard 3 of the NSF. This standard discusses patient empowerment and involving patients in their own care. A number of education programmes have been set up to empower patients to better manage their diabetes, and two of these are explored in detail: Dose Adjustment for Normal Eating (DAFNE) and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). Research has shown however, that many people are not aware of these initiatives, suggesting that more needs to be done to ensure that patients, nurses and other health professionals are aware of the services available for people with diabetes in the community. Furthermore, research suggests that there is a lack of emotional and psychological support for patients living with this chronic condition. It is suggested here that nurses can provide patients with this support, as well as with information to help them access services to manage their diabetes. This, together with education about diet and exercise, and appropriate referrals, will enable the nurse to ensure that all patients receive high-quality care.

Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis

Objectives To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people...

‘Educator talk’ and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial

To determine whether differences in the amount of time educators talk during a self-management education programme relate to the degree of change in participants' reported beliefs about diabetes. Educators trained to be facilitative and non-didactic in their approach were observed delivering the DESMOND self-management programme for individuals newly diagnosed with Type 2 diabetes. Observers used 10-s event coding to estimate the amount of time educators spoke during different sessions in the programme. Facilitative as opposed to didactic delivery was indicated by targets for levels of educator talk set for each session. Targets were based on earlier pilot work. Using the revised Illness Perceptions Questionnaire (IPQ-R) and the Diabetes Illness Representations Questionnaire (DIRQ), participants completed measures of: perceived duration of diabetes (timeline IPQ-R), understanding of diabetes (coherence IPQ-R), personal responsibility for influencing diabetes (personal responsibility IPQ-R), seriousness of diabetes (seriousness DIRQ) and impact on daily life (impact DIRQ), before and after the education programme. Where data from the event coding indicated educators were talking less and meeting targets for being less didactic, a greater change in reported illness beliefs of participants was seen. However, educators struggled to meet targets for most sessions of the programme. The amount of time educators talk in a self-management programme may provide a practical marker for the effectiveness of the education process, with less educator talk denoting a more facilitative/less didactic approach. This finding has informed subsequent improvements to a comprehensive quality development framework, acknowledging that educators need ongoing support to facilitate change to their normal educational style.

Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial

Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial

Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial

Objective To evaluate the effectiveness of a structured group education programme on biomedical, psychosocial, and lifestyle measures in people with newly diagnosed type 2 diabetes.Design Multicentre cluster randomised controlled trial...

Diabetes education and self-management for ongoing and newly diagnosed (DESMOND): Process modelling of pilot study

Objective To determine the effects of a structured education program on illness beliefs, quality of life and physical activity in people newly diagnosed with Type 2 diabetes. Methods Individuals attending a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) program in 12 Primary Care Trusts completed questionnaire booklets assessing illness beliefs and quality of life at baseline and 3-month follow-up, metabolic control being assessed through assay of HbA1c. Results Two hundred and thirty-six individuals attended the structured self-management education sessions, with 97% and 64% completing baseline and 3-month follow-up questionnaires. At 3 months, individuals were more likely to: understand their diabetes; agree it is a chronic illness; agree it is a serious condition, and that they can affect its course. Individuals achieving a greater reduction in HbA1c over the first 3 months were more likely to agree they could control their diabetes at 3 months ( r = 0.24; p = 0.05), and less likely to agree that diabetes would have a major impact on their day to day life ( r = 0.35; p = 0.006). Conclusion Pilot data indicate the DESMOND program for individuals newly diagnosed with Type 2 diabetes changes key illness beliefs and that these changes predict quality of life and metabolic control at 3-month follow-up. Practice implications Newly diagnosed individuals are open to attending self-management programs and, if the program is theoretically driven, can successfully engage with the true, serious nature of diabetes.

24th Isle of Wight diabetes conference

24th Isle of Wight diabetes conference