The diabetes annual review in a box: How a postal review can increase engagement and reduce the burden of diabetes

Abstract

In the UK, people with diabetes are offered annual review appointments which help to prevent or delay diabetes-related complications. Non-attendance at these appointments is associated with higher glycated haemoglobin (HbA1c) levels and worse health outcomes.
My project aims to determine the feasibility of people with diabetes performing their annual review at home using a postal kit. This kit would allow them to collect finger-prick blood samples, urine samples, and anthropometric data.
I performed a systematic review exploring accuracy, reliability, and acceptability of capillary blood sampling for the measurement of HbA1c. The level of agreement between microtube/capillary tube HbA1c results and venous HbA1c results were high. Samples were stable for five to eight days. Although the participant-reported acceptability concerning the use of self-collection kits appeared high, the generalisability of these findings was limited.
I also conducted semi-structured interviews and focus groups with adults with diabetes. I explored their ideas, concerns, and expectations. I sent half of the study invites to people who infrequently attended annual review appointments. Transcripts were collated and analysed thematically. All participants identified as infrequent attendees at annual review appointments responded positively to the kit. Most participants who regularly attended annual review appointments also responded positively. The participants valued having information about why each test was beneficial and they wanted clearer communication of their results. The participants suggested the kit could be used to shape their future consultations by allowing them to highlight areas of personal importance.
I then conducted virtual semi-structured interviews and focus groups with healthcare professionals involved in the delivery of diabetes care. I recruited people from a range of different roles within the healthcare system and included people from both primary and secondary care. I explored their experiences of non-attendance behaviour in people with diabetes and their views on how a postal annual review kit might impact this. I explored their thoughts about how a postal annual review kit might be implemented within the current service. Healthcare professionals recognised how the postal kit might reduce barriers to attendance for people with diabetes. They felt it had the potential to free up consultation time and allow more flexibility. They emphasised how manual data entry may increase the administrative burden of such a kit and suggested methods of reducing this such as electronic questionnaires.
In my final chapter, I review my findings in the context of the wider literature regarding capillary blood testing and remote healthcare delivery. I discuss what further research would be beneficial to facilitate the design and implementation of a postal kit. Lastly, I conclude whether my findings support whether a postal kit is a feasible option for delivering the diabetes annual review.

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Identifiers

ORCID for Hajira Dambha-Miller: orcid.org/0000-0003-0175-443X

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