Diabetes In Primary Health Care Research Articles

Interprofessional follow-up for people at risk of type 2 diabetes in primary healthcare – a randomized controlled trial with embedded qualitative interviews

Objective To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants’ perceptions of participating in the intervention. Design and methods In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019–2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data. Results There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: ‘Meaningful perspectives on lifestyle changes’ and ‘Lifestyle change is not a linear process due to challenges faced along the way’ putting ownership of their choices in life into picture. Conclusion The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.

Educational technologies for women with gestational diabetes in primary care: scope review protocol

Introduction: Educational technologies are tools that contribute to the effectiveness of gestational diabetes interventions in the scope of basic care, providing the pregnant woman's autonomy in making decisions about her health. Objective: To map the educational technologies offered to women with gestational diabetes in Primary Health Care (PHC). Method: Scope review, following the JBI Manual for Evidence Synthesis methodology and checklist of the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR). It has as its review question: what educational technologies are offered to women with gestational diabetes in Primary Health Care? The preliminary search was carried out on December 28, 2023, in the databases Virtual Library on Health, Web of Science and Scopus. The studies will be grouped into Rayyan software and the duplicates removed. The selected citations will be evaluated, following the inclusion criteria, by two independent reviewers and, in case of disagreement, another researcher will be requested. It is expected to broaden the knowledge about the educational technologies available for the treatment of gestational diabetes, assisting in health promotion strategies aimed at pregnant women in PHC, considering the social constraints to which they are exposed.

Epidemiological profile of type 2 diabetic patients followed at a secondary care referral center: Data from a Moroccan cohort study

BackgroundType 2 diabetes is a major public health problem responsible for several macro and microvascular complications, including diabetic nephropathy. The main objective of this study was to describe the epidemiological profile of type 2 diabetic patients at admission to a reference center for chronic diseases and to explore associated factors with a glomerular filtration rate decline (GFR). MethodsThis retrospective cohort study aims to examine the epidemiological characteristics of patients with type 2 diabetes who had at least one consultation between November 2005 and December 2020. ResultsThe study included 19,953 patients, of whom 67.8 % were women, with an average age of 58.2 ± 12.2 years. The majority (64.7 %) had a diabetes duration of less than 5 years. On admission, 37.6 % of patients had high blood pressure, 41.8 % were overweight, while 31.5 % were obese. Nearly 9 % of patients had at least one complication on admission: 2.6 % had heart disease, 2 % had nephropathy, 1.8 % had retinopathy, 0.7 % had neuropathy and 0.5 % had a diabetic foot. The study found that 76.8 % of patients had poorly controlled diabetes, and 30.1 % had a GFR 〈 60 ml/min/1.73 m². Women, patients over 65 years, those with a diabetes duration 〉 30 months, hypertensive patients, those with at least one complication on admission, patients with overweight or obesity, and those with positive albuminuria had significantly lower GFR (p < 0.001). ConclusionOur study showed that most patients were initially diagnosed with Type 2 diabetes in primary healthcare and had a very high risk of complications. Primary care health centers may not have sufficient human and material resources to effectively screen for and monitor these complications. Therefore, it is crucial to strengthen secondary care referral centers to ensure comprehensive and optimal management of diabetes patients, including diabetic control and early detection and management of its complications.

A short tool to screen self-care preparedness: cross-sectional study in general practice

Abstract Background Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care. Objectives This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes. Methods A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI. Results A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance. Conclusions SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.

Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural

ObjectiveTo investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. DesignCross-sectional or prevalence descriptive study. LocationRural health basic area in Spain. Primary health care level. Participants500 patients over 18 years old with diabetes. Main measurementsStudy of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors –smoking, hypertension and hyperlipidemia– and the characteristics of the diabetes –type, evolution time, treatment, metabolic control and renal function–. ResultsThe findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. ConclusionsIt is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.

Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar.

Aims/IntroductionThis study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar.Materials and MethodsThis was a cross‐sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN.ResultsA total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity.ConclusionsThe prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.

The Need for Lean Thinking in the KuwaitiHealthcare System

Healthcare systems (HCS) all over the world are facing escalating challenges as a consequence of increasing life expectancy and the growth of the ageing population. Even more, the financial constraints facing most countries are adding to the current crisis. Growing healthcare costs are directing the attention of many governments for investing to improve the efficiency of their HCS. Many developed countries have had massive investment in order to improve their service efficiency, but this is not the case in Kuwait. To address some of these challenges, several institutes and organisations have adopted manufacturing improvement methods and techniques. One noticeable improvement approach that promises to improve quality and efficiency while reducing costs is lean management. As part of a threeyear PhD research project, this article is looking through the literature to explore the feasibility and motivation factors of studying lean thinking in the Kuwaiti healthcare system. The aim is to identify the gaps and direct future research to the right path, to understand the potential for applying lean thinking in Kuwait and rationing the selected area where a pilot project intends to be conducted. This review article will critically examine the potential for lean management to be implemented in Kuwait’s HCS. Even though the first published study regarding lean implementation in healthcare is 15 years old, the research and knowledge of lean health management is at the infant stage. It found that lean has the potential yet inconsistent benefits on process outcomes like patient flow; lacks rigorous evaluation with missing of the control group; superficial input from patients; narrow technical application with limited organisational reach. The other finding was that lean was not explored in primary healthcare and there is a deficiency in projects within developing countries. The key findings from literature have driven researchers and organisations to undertake further research on the use of lean in healthcare. In light of the above, it is worthwhile exploring the case for adopting lean in Kuwait to enhance the flow of patients with diabetes in primary healthcare.

Cost-effectiveness analysis of glycaemic control of a glucose monitoring system (FreeStyle Libre®) for patients with type 1 diabetes in primary health care of Burgos

ObjectiveThis study seeks to evaluate the clinical effectiveness and cost-effectiveness of FreeStyle Libre® versus traditional monitoring in patients with type 1 Diabetes Mellitus in the Health Area of Burgos (Spain). MethodA transversal ambispective descriptive study was carried out to compare costs and effectiveness between two forms of glycaemic control. The information was obtained from the computerized clinical history (Medora) and by referring to patients. An analysis of the monitoring material and clinical glycaemic control variables (HbA1c and symptomatic hypoglycaemia events, <70mg/dl) were carried out one year before and one year after the start of FreeStyle Libre®. ResultsWe included 23 patients with 1 of 35.4 (±15.1) years old (60.9% males). Monitoring by FreeStyle Libre® system has an average annual cost per patient four times higher than the traditional method. The HbA1c level was reduced by 5% (p=.024) and the rate of symptomatic hypoglycaemia decreased by 58.9% (p=.013). This determines an effectiveness in the Absolute Risk Reduction of .232 (23.2%) of hypoglycaemia and an incremental cost-effectiveness of €6194.71. ConclusionsThe FreeStyle Libre® system has a high clinical effectiveness associated with a high but potentially acceptable cost for glycaemia monitoring in Type 1 Diabetes Mellitus.

Insulin therapy practice performed by people with diabetes in Primary Healthcare.

To analyze insulin therapy performed by people with diabetes in Primary Healthcare. A cross-sectional, descriptive and quantitative study. Data collection was carried out through an interview using a form with sociodemographic, clinical and insulin therapy variables. Absolute and relative frequencies as well as prevalence ratio were calculated and the chi-squared test was used, with p<0.05 being significant. The sample consisted of 150 patients. Most were female (66.7%), aged 50-85 years (79.3%) and some were illiterate (16.7%). Type 2 diabetes (62.0%) with complications (42.7%), and using oral hypoglycemic agents and insulin stood out. Syringes/needles (83.1%), lancets (85.5%), reagent strips (91.0%) and insulin vials (93.8%) were stored incorrectly by the majority. The correct form predominated in preparation, application and transport. Waste was disposed of incorrectly. In the general analysis most performed the insulin therapy stages inappropriately (93.3%). Sociodemographic and clinical variables did not influence insulin therapy, but there was a significant difference in the intra-group analysis for incorrect performance in some groups. Insulin therapy was inappropriately performed in most cases.

Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain

BackgroundType 2 diabetes is a growing health challenge in the Kingdom of Bahrain, and the disease exerts significant pressure on the healthcare system. The aim of this study was to assess the annual costs and understand the drivers of those costs in the country.MethodsA sample of 628 patients diagnosed with type 2 diabetes were randomly selected from primary healthcare diabetes clinics, and the direct medical and indirect costs due to type 2 diabetes were analysed for a one-year period. The study used patients’ medical records, interviews and standardised frequency questionnaires to obtain data on demographic and clinical characteristics, complication status, treatment profile, healthcare resource utilisation and absenteeism due to diabetes. The indirect costs were estimated by using the human capital approach. The direct medical and indirect costs attributable to type 2 diabetes were extrapolated to the type 2 diabetes population in Bahrain.ResultsIn 2015, the total direct medical cost of type 2 diabetes was 104.7 million Bahraini dinars (BHD), or 277.9 million US dollars (USD), and the average unit cost per person with type 2 diabetes (1162 BHD, or 3084 USD) was more than three times higher than for a person without the condition (372 BHD, or 987 USD). The healthcare costs for patients with both micro- and macrovascular complications were more than three times higher than for patients without complications. Thus, 9% of the patients consumed 21% of the treatment costs due to complications. Complications often lead to hospital admission, and 20% of the patients consumed almost 60% of the healthcare costs attributable to type 2 diabetes due to hospital admissions. The indirect cost due to absenteeism was 1.23 million BHD (3.26 million USD).ConclusionType 2 diabetes exerts significant pressure on Bahrain’s healthcare system – primarily due to costly diabetes-related complications. It is therefore important to optimise the management and control of type 2 diabetes, thereby reducing the risk of disabling and expensive complications.

Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): the protocol of a mixed-methods study including a cluster randomised controlled trial

IntroductionIn Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based...

Identifying the Prevalence and Risk Factors Associated With Uncontrolled Diabetes (Type 2) in Al Buraimi Governorate, Sultanate of Oman

BACKGROUND: People with poorly controlled diabetes are likely to have shortened life, diabetes related complications and also reduced quality of life. WHO-EMRO region is considered to be the highest prevalence region accounted 43 million people. Among GCC countries, Oman has reported increased number of cases in recent years. &#x0D; &#x0D; OBJECTIVE: To identify the prevalence and risk factors associated with uncontrolled diabetes (Type 2) in a diabetic setting of Al Buraimi Polyclinic, AL Buraimi Governorate, Oman.&#x0D; &#x0D; METHODOLOGY: This Cross sectional retrospective study was conducted in diabetic clinic of Al Buraimi Polyclinic of primary health care, Al Buraimi Governorate Oman between January-April 2015. This study enrolled all diabetic patients type 2 (N=1164) who were registered during the period 2010-2014 in the polyclinic. Data was retrieved from the electronic diabetic register and patient&amp;rsquo;s electronic records in a diabetic setting at Al Buraimi Polyclinic. Descriptive statistics were applied to analyze the data. Differences between the groups were analyzed by using Chi-square test in SPSS 16 with p value &amp;le; 0.05 significance level.&#x0D; &#x0D; RESULTS: Prevalence of Uncontrolled Diabetes Mellitus Type 2 was found to be 623 (54%) among 1164 registered patients. 1108 (95%) were Omani nationals and 56 (5%) were non-Omani nationals with mean age 51&amp;plusmn;12 and male predominance 632 (54%) with higher significance (p-value=0.009). A significant association was found between treatment and glycemic control (p-value = 0.000) with 926 (80%) were on oral hypoglycemic agents. Moreover, HbA1c was significantly associated with total cholesterol, Low density lipoprotein and Triglyceride with (p-value=0 .000). 629 (54%). Diabetic patients were having family history as a common risk factor.&#x0D; &#x0D; CONCLUSION: Uncontrolled diabetes mellitus with prevalence &amp;gt;50% implies an alarming challenge to health care system. An intervention should be focused on patient&amp;rsquo;s education, emphasizing on life modification strategies. Furthermore, multidisciplinary approach is needed for the effective care of diabetes in primary health care.

EFEITO DE UM PROGRAMA EDUCACIONAL EM EMPODERAMENTO DO AUTOCUIDADO PARA CUMPRIMENTO DE METAS EM DIABETES

Objective: To evaluate the effect of an educational program based on the empowerment of self-care practices to favor the fulfillment of goals in users with type 2 diabetes in Primary Health Care. Methods: Pre-post quasi-experimental study, performed for 12 months with 127 users with type 2 diabetes mellitus, enrolled and followed up in an educational program for the empowerment of self-care practices. The following variables were evaluated: sociodemographic data collected through an interview and a specific instrument created for the research, clinical and metabolic characteristics collected by means of blood tests, degree of empowerment gathered through the Empowerment Scale, and goals fulfillment by means of interview and the specific instrument created for the research. Results: Among the participants, 33.9% (43) of users self-reported partially meeting, and 66.1% (84) fully meeting the goals, favoring a behavior change and improving diabetes control. Regarding empowerment, the chance of achieving the total goals in the group with the highest score is 2.98 times that of the group with the lowest score (95% CI: 1.30-6.86). Conclusion: It was evidenced that the educational program based on the empowerment of self-care practices favored the achievement of goals in users with type 2 diabetes in Primary Health Care.

Long term results and determinants of outcomes in primary health care diabetes prevention. The DE-PLAN project

Long term results and determinants of outcomes in primary health care diabetes prevention. The DE-PLAN project

Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project.

It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners’ (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69–0.92 and OR 0.52, 95% CI 0.27–0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01–3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.

Prevention of diabetes in primary healthcare based on the health policy program for early detection and prevention of diabetes and its complications in working individuals in the professionally active people, in the lubuskie province

Prevention of diabetes in primary healthcare based on the health policy program for early detection and prevention of diabetes and its complications in working individuals in the professionally active people, in the lubuskie province

Diabetes Self-Management: A Key to Better Health-Related Quality of Life in Patients with Diabetes

Objective: The aims of this study were to assess health-related quality of life (HRQOL) among adult patients with diabetes attending primary health care diabetes clinics in Kuwait and to examine the factors associated with the HRQOL of patients with diabetes. Methods: This cross-sectional study was conducted among 503 patients with diabetes attending 26 primary health care diabetes clinics in Kuwait. A self- administered questionnaire on participants’ socio-demographic and clinical characteristics, in addition to the Diabetes Self-Management Questionnaire (DSMQ) to assess patients’ diabetes self-management (DSM), was used. The SF-12 was employed to assess the HRQOL, producing the following 2 outcomes: physical health composite (PHC) and mental health composite (MHC). Results: The mean age of participants was 52 ± 0.8 years, and 53.1% were males and 49.0% were Kuwaitis. The median DSM sum score was 6.5. Male patients with diabetes showed a significantly better median DSM sum score than female patients with diabetes. The overall median score of HRQOL was 61.7/100, with a better median PHC versus MHC score of quality of life (66.7/100 and 56.7/100, respectively). Multivariate analysis revealed a significant direct association between DSM and better primary health composite and MHC scores. It also showed that female gender and reporting 2 or more diabetic complications were significantly associated with a poor PHC. Conclusions: Kuwaiti patients with diabetes showed a modest level of HRQOL. Patients’ DSM, gender, and diabetes complications were significant independent correlates to HRQOL. Appraisal of the HRQOL of patients with diabetes as an essential component of diabetes management in clinical settings is suggested. Further studies to examine the impact of good DSM on HRQOL improvement are needed.

Study protocol for \u201cMOVEdiabetes\u201d: a trial to promote physical activity for adults with type 2 diabetes in primary health care in Oman

BackgroundBenefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman.Methods/designThe study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention) versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week), pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week) over 12 months, (at a power of 80%, and significance level of 5%), 128 participants would be required to complete the study (64 in each arm). Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm). Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All intervention delivery and support costs will be monitored.DiscussionThis study will contribute to the evidence on the feasibility, cultural acceptability and efficacy of interventional approaches for increasing physical activity in primary care for persons with type 2 diabetes in Oman.Trial registrationInternational Standard Randomised Controlled Trials No: ISRCTN14425284. Registered 12 April 2016.

Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study.

To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. Subjects at increased risk of developing type 2 diabetes were included. It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.

Health Beliefs of People with Type 2 Diabetes in Primary Health Care in Muscat, Oman: A Qualitative Approach

Background: With recent affluence, Oman has witnessed a dramatic increase in the number of Omani nationals with type 2 diabetes. Most national studies have focused on quantifying the magnitude of the problem, and issues related to co-morbidity. The purpose of this study was to explore the health beliefs associated with diabetes self-management among adult Omani patients with type 2 diabetes. Methods: This study employed the Health Belief Model (HBM) as the theoretical framework. A structured open-ended interview question guide was developed based on the constructs of the HBM and based on literature regarding various factors associated with diabetes management. The study was conducted in seven conveniently selected Primary Health Care (PHC) centers in the Muscat Governorate. In total 29 patients with type 2 diabetes were invited at convenience, while visiting the centers for regular follow ups, to participate and were interviewed based on written consents. Results: Applying the HBM with this group of patients indicated to six factors as barriers to diabetes self-care: (1) cost of self-monitoring for blood glucose level, (2) social interactions, (3) negative feelings associated with living with the disease, (4) lack of accurate practical and culturally-sensitive health education about diet and exercise, (5) fatalism, and (6) low self-efficacy. Diabetes self-management education was not valued and a large number (19/29) did not actively seek information about diabetes. Conclusion: The findings here point to the urgent need for a culturally appropriate diabetes education program with respected to the health beliefs indicated here.