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Development of a supported self-management intervention for people with severe mental illness and type 2 diabetes: theory and evidence-based co-design approach

Development of a supported self-management intervention for people with severe mental illness and type 2 diabetes: theory and evidence-based co-design approach
Development of a supported self-management intervention for people with severe mental illness and type 2 diabetes: theory and evidence-based co-design approach
Background: type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services.

Objective: we combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI.

Methods: the development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence.

Results: upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes.

Conclusions: the intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial.




1438-8871
Carswell, C.
84173558-048e-481a-9036-0c1aac92fb9e
Coventry, P.
3577d566-6242-407b-ba87-e51d9305566b
Brown, J.
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Alderson, S.L.
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Double, Keith
a156cf38-93ed-4ed5-95bc-3d0d8646cc49
Gilbody, Simon
075b0740-2868-4bcf-812b-c7f1d53cbb2c
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Jacobs, R.
eefc9146-41e3-4c3c-a518-0dae5a4b91f6
Lister, Jennie
b50d19c2-0e8d-40f9-8d7e-72c038c1d7cd
Osborn, David
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Shiers, David
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Siddiqi, Najma
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Taylor, J.
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Kellar, I.
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DIAMONDS Research Team
Carswell, C.
84173558-048e-481a-9036-0c1aac92fb9e
Coventry, P.
3577d566-6242-407b-ba87-e51d9305566b
Brown, J.
57cde7f5-a89c-4f9d-b434-68e8035ce2bb
Alderson, S.L.
a0d4a424-cac0-4077-80f7-b6b3b2cb3f11
Double, Keith
a156cf38-93ed-4ed5-95bc-3d0d8646cc49
Gilbody, Simon
075b0740-2868-4bcf-812b-c7f1d53cbb2c
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Jacobs, R.
eefc9146-41e3-4c3c-a518-0dae5a4b91f6
Lister, Jennie
b50d19c2-0e8d-40f9-8d7e-72c038c1d7cd
Osborn, David
550016bf-ae8b-434f-a07e-8f5b5f8376dd
Shiers, David
2cda5b73-f572-4e67-a578-39611db197d3
Siddiqi, Najma
5ce4e448-269b-464d-88a4-be1f9bdea426
Taylor, J.
0deca1ea-0257-444c-beea-247981c731a4
Kellar, I.
761390b0-e9d3-4fb5-9d77-3db8994d4ef3

DIAMONDS Research Team (2023) Development of a supported self-management intervention for people with severe mental illness and type 2 diabetes: theory and evidence-based co-design approach. Journal of Medical Internet Research, 25, [e43597]. (doi:10.2196/43597).

Record type: Article

Abstract

Background: type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services.

Objective: we combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI.

Methods: the development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence.

Results: upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes.

Conclusions: the intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial.




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Accepted/In Press date: 14 March 2023
e-pub ahead of print date: 12 May 2023

Identifiers

Local EPrints ID: 477196
URI: http://eprints.soton.ac.uk/id/eprint/477196
ISSN: 1438-8871
PURE UUID: 5b0d9858-0374-4421-838b-119fba2f7239
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 01 Jun 2023 16:32
Last modified: 02 Jun 2023 01:35

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Contributors

Author: C. Carswell
Author: P. Coventry
Author: J. Brown
Author: S.L. Alderson
Author: Keith Double
Author: Simon Gilbody
Author: Richard Holt ORCID iD
Author: R. Jacobs
Author: Jennie Lister
Author: David Osborn
Author: David Shiers
Author: Najma Siddiqi
Author: J. Taylor
Author: I. Kellar
Corporate Author: DIAMONDS Research Team

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