Effectiveness of a Training Course for General Practice Nurses in Motivation Support in Type 2 Diabetes Care: A Cluster-Randomised Trial

Abstract

BackgroundType 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population.MethodsForty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory - based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40–74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed.ResultsThe differences between the intervention- and the control practices’ mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: −0.02%-points (95% CI: −0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: −0.12%-points (−0.23 to −0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01.ConclusionsOffering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention.Trial RegistrationClinicalTrials.gov (Identifier NCT01187069).

The effectiveness of interventions to enhance self‐management support competencies in the nursing profession: a systematic review

“…); and one study at more than 6 months post training (Juul et al . ). Three studies with positive results relied on observational methods (Lane et al .…”

“…, Juul et al . ). The five effective training interventions were characterized by the following didactic components (Supporting Information File S5, Figure 5–7): single or multiple sessions, all with follow‐up between 2 and 5 months after initial training (Lane et al .…”

“…) or follow‐up more than 6 months after initial training (Juul et al . ). All effective interventions included time to practice and discussion and reflection moments (Lane et al .…”

“…, Pfister‐Minogue & Salveson , Juul et al . , Mahramus et al . ); and three provided individual feedback on performance (Pfister‐Minogue & Salveson , Juul et al .…”

“…); and three provided individual feedback on performance (Pfister‐Minogue & Salveson , Juul et al . , Mahramus et al . ).…”