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A facilitated web-based self-management tool for people with Type 1 diabetes using an insulin pump: intervention development using the behavior change wheel and theoretical domains framework

A facilitated web-based self-management tool for people with Type 1 diabetes using an insulin pump: intervention development using the behavior change wheel and theoretical domains framework
A facilitated web-based self-management tool for people with Type 1 diabetes using an insulin pump: intervention development using the behavior change wheel and theoretical domains framework
Background: Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions.

Objective: the aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM.

Methods: focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention.

Results: a total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information—the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences—taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs—HCPs acknowledge the patient’s need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues.

Conclusions: the use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs’ apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.
Behavior change wheel, Continuous subcutaneous insulin infusion, Self-management, Social support, Type 1 diabetes, Web-based intervention
1438-8871
Reidy, Claire
d500bfe7-7429-4484-b092-60ef0757d0de
Foster, Claire
00786ac1-bd47-4aeb-a0e2-40e058695b73
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Reidy, Claire
d500bfe7-7429-4484-b092-60ef0757d0de
Foster, Claire
00786ac1-bd47-4aeb-a0e2-40e058695b73
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7

Reidy, Claire, Foster, Claire and Rogers, Anne (2020) A facilitated web-based self-management tool for people with Type 1 diabetes using an insulin pump: intervention development using the behavior change wheel and theoretical domains framework. Journal of Medical Internet Research, 22 (5), [e13980]. (doi:10.2196/13980).

Record type: Article

Abstract

Background: Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions.

Objective: the aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM.

Methods: focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention.

Results: a total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information—the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences—taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs—HCPs acknowledge the patient’s need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues.

Conclusions: the use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs’ apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.

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More information

e-pub ahead of print date: 11 March 2020
Published date: 1 May 2020
Additional Information: ©Claire Reidy, Claire Foster, Anne Rogers. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.05.2020.
Keywords: Behavior change wheel, Continuous subcutaneous insulin infusion, Self-management, Social support, Type 1 diabetes, Web-based intervention

Identifiers

Local EPrints ID: 441005
URI: http://eprints.soton.ac.uk/id/eprint/441005
ISSN: 1438-8871
PURE UUID: 384b9604-44c2-4bac-83b9-a156d5003018
ORCID for Claire Reidy: ORCID iD orcid.org/0000-0002-0013-6843
ORCID for Claire Foster: ORCID iD orcid.org/0000-0002-4703-8378

Catalogue record

Date deposited: 27 May 2020 16:53
Last modified: 23 Jul 2022 01:53

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