Diabetes Capabilities for the Healthcare Workforce Identified via a 3-Staged Modified Delphi Technique

Abstract

Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60[71%]), allied health (n = 17[20%]), and pharmacy (n = 7[9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability—259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research.

Enhancing the capacity of the health workforce to deliver best practice diabetes care

“…13,[25][26][27][28][29][30] Competency frameworks are tied to one-dimensional views of learning, healthcare roles, and discipline requirements and do not recognise the benefits of autonomous practice that enable innovation, hindering expertise. 16,24,31 In Australia, there is no diabetes framework to inform the entire workforce, nor are any frameworks, internationally or nationally, capability-based to accommodate dynamic healthcare changes. 13 The lack of these frameworks compromises consistency in advice and clinical care delivered, limiting sustainable health workforce development.…”

“…13 The lack of these frameworks compromises consistency in advice and clinical care delivered, limiting sustainable health workforce development. 16,24…”

“…32,[37][38][39][40] Capability-based learning offers an innovative alternative to current frameworks. 13,16 It is based on Sen's capability approach, a moral framework describing how opportunities are made feasible and are constrained by internal (personal) and external (social and environment) factors. 41,42 It encompasses competency and extends beyond technical skills, promoting self-efficacy supported by emphasising adaptability and lifelong learning.…”

“…47 A framework that increases the capability of non-medical HCPs to deliver diabetes care was identified by consensus via a 3-staged modified Delphi technique from a purposefully recruited diverse panel of Australian diabetes-experts with representation from all Australian healthcare sectors (see Supplementary material). 13,16 Capability framework for diabetes care (the 'Framework')…”

“…13 Primary HCPs report inadequate skills, confidence, time or access to resources as common barriers to delivering person-centred diabetes care, often due to lack of preparedness from undergraduate degrees. [13][14][15][16] An inadequately diabetes-trained health workforce can lead to improper clinical care, longer hospitalisation, re-admission, and conflicting advice, leading to disengagement with health services, low health literacy and reduced self-care practices. [17][18][19][20] These consequences increase personal and financial burdens on people with diabetes and the health system.…”