Dr Charlotte Dack, University of Bath

Transcription

1 Developing HeLP-Diabetes: An internet self-management intervention for people with Type 2 Diabetes Dack, C., Ross, J., Pal, K., Stevenson, F., Michie, S. & Murray, E. Dr Charlotte Dack, University of Bath c.n.dack@bath.ac.uk This project was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG ). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

2 Aims for today s talk Why? How? Emphasis on: Theoretical underpinning User participation Next steps

3 Why? Policy More Efficient Care Current Policy Improved Health Outcomes Use Of ICT Self- Management for LTCs Improved Quality of Care Decreased Health Cost

4 Why?: Diabetes & Self-management Structured education programmes can improve health outcomes and quality of life <10% patients report access to structured education (2011) UK DM education mostly group-based Not suitable for everyone

5 Internet Interventions Why? Convenience, accessibility, anonymity Just in time information Interactivity, enabling: Behaviour change support Decision support Emotional support Peer support

6 BUT. Evidence of internet interventions efficacy is weak Interventions may not work Poor implementation track record High attrition rates/problems with engagement Digital divide / health inequalities

7 How?:Developing HeLP-Diabetes Evidence Theory/ Framework HeLP-Diabetes User Participation Commercial Input

8 Features Presentation What did patients & HP s say? Patients (n = 20) Health Professionals (n = 17) Info, Hyperlinks, Tools for selfmonitoring, Quizzes, Ask the Expert, Videos, Personal Stories Consistent, Colourful, Easy to navigate, Interactive & Visual, Accessible language Info, Tools for self-monitoring, Emotional Support Interactive and visual Simplicity is key Tone Positive, Supportive, Humorous Positive, Motivating Engagement Referral, Text & s, Peer Support, Tailored Save time, Fit in with QOF, Endorsed, Positive trial data Dislikes Crowded text, Medical jargon, Adverts, Broken links, Americanised More work

9 Integrating Theory 1. Corbin & Strauss tasks for self-management 2. Individual behaviour change 3. Implementation and Normalization Process Theory

10 What do patients need? Behavioural Management Emotional Management B E Role Management R Corbin and Strauss: Unending Work and Care. 1988

11 Individual Behaviour Change For each BC module we used the following BCT s: Information provision Self-assessment tools Personalised goal setting, action planning, review, self-monitoring/feedback Additional behaviour change techniques from Michie s taxonomy as appropriate

12 Why goal setting, action planning & feedback? Self-monitoring/Feedback effective across behaviours Psychological theory to predict combinations of techniques that might be more effective Self-regulation (Control) Theory* suggests how feedback may interact with other techniques to change behaviour *Carver & Scheier, 1982

13 Normalization Process Theory Organizing structures and social norms Impact on consultations and relationships Does it make sense? (Coherence) Do I want to take part? (Cognitive Participation Impact on work (Collective Action) Is it worth it? (Reflexive Monitoring) Fit with existing skill set and organisational goals and resource Group processes and conventions May & Finch; Sociology 2009

14 What?: Components of HeLP-Diabetes Living and Working Treating Diabetes Understanding Diabetes R B B Forum & Help Health Record Managing My Feelings E R B E Staying Healthy Healthy Eating Physical activity Smoking cessation Alcohol Taking medicines Working with health professionals Each module contains: self-assessment tools, goal setting, action plans, self-monitoring, Review Feedback B

15 RCT in Primary Care Intervention Vs. Control

16 Implementing HeLP-Diabetes Uptake & Use Barriers & Facilitators Resource needed Ross, J., Stevenson, F., Dack, C., Pal, K., May., C., Michie, S., Parrott, S., & Murray, E. (2014). Evaluating the implementation of HeLP-Diabetes within NHS services: study. BMC Health Services Research.

17 Thank you! Dr Charlotte Dack, University of Bath This project was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG ). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.