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

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.

Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review

“…Zuidema et al [ 19 ] did not find any positive effects associated with a web-based tool to support self-management. This was surprising as the interventions were similar in both content and theory to other online self-management interventions which show positive effects in other chronic conditions [ 44 – 46 ]. Zuidema et al [ 19 ] concluded that this could be due to the outcome measures chosen or perhaps the need to add a tailoring aspect to their intervention.…”

Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians

“…52 The BCW 54 55 is a 'theory and evidence based' intervention development approach 58 that provides guidance on considering and identifying the function of interventions (eg, education, persuasion, enablement) and policy categories that may support the delivery of these functions (eg, guidelines, service provision, environmental planning) and how these both link to MoAs and/or BCTs. The TDF and related resources have been used to inform the development and evaluation of health-focused behavioural interventions, [59][60][61] including informing the data collection and/or analysis of qualitative studies forming an early stage in the process of intervention development. [62][63][64][65] Data collection: interview content and procedures Participants will take part in one semistructured qualitative interview lasting around 45 min, though duration is likely to be variable depending on how much a participant wishes to say and their preferred interview pace.…”

Identifying barriers and enablers to rigorous conduct and reporting of preclinical laboratory studies

“…For example, the "Theoretical Domains Framework" synthesizes theories of behavior change into 14 "domains" [19,20] that reflect major influences on enacting a behavior (TDF; see S1 File for domains and definitions) [21]. Barriers and enablers to behavior identified by the TDF can be combined with other frameworks (Behaviour Change Wheel (BCW); Expert Recommendations for Implementing Change (ERIC)) [21][22][23] to guide development of strategies to help adopt behaviors of interest [21,[24][25][26][27][28][29]. In the present study, we drew upon this approach to interview preclinical scientists and systematically examine the barriers and enablers to using preclinical guidelines and identify strategies that might improve their uptake.…”