Improving the Implementation of Diabetes Self-Management

Abstract

To enhance the health and well-being of patients managing type 2 diabetes, the five grantees comprising the Alliance to Reduce Disparities in Diabetes implemented evidence-based approaches to patient self-management education as part of their programs. This article describes strategies implemented by the grantees that may help explain program success, defined as improvement in clinical values and patient-reported outcomes. A process evaluation of grantee programs included interviews and document review at the beginning, midpoint, and end of the Alliance initiative. A total of 97 interviews were conducted over time with 65 program representatives. The Alliance programs served 2,328 people from diverse racial and ethnic backgrounds and provided 36,826 diabetes self-management sessions across the intervention sites. Framework analysis of the interviews identified four key themes that emerged across time and program sites that may help account for program success: empowerment, increasing access and support, addressing local needs and barriers, and care coordination. The overall evaluation findings may help other diabetes self-management programs seeking to translate and implement evidence-based approaches to reduce disparities and enhance patient well-being.

Barriers and Facilitators in Implementing Non-Face-to-Face Chronic Care Management in an Elderly Population with Diabetes: A Qualitative Study of Physician and Health System Perspectives

“…Management of diabetes among older adults is complicated and includes issues related to cognitive and functional decline, and diabetes management in this population may have different aims than in younger populations. A study by Lewis and colleagues found that care management enhanced patient empowerment and addressed local barriers and individual needs with coordination of resources from a variety of settings [ 7 ], whereas the present results indicated that coordination of multiple programs addressing diabetes and its complications may hinder accessing the benefits of care management due to complex systems. Another qualitative study focusing on care coordination for insulin initiation in patients with diabetes explored different clinician perceptions of roles as they pertained to developing relationships with clear communication, trust, and respect [ 18 ].…”

“…Complications are largely preventable with medication and behavioral interventions [ 4 , 5 ]. However, the disease remains prevalent in the US and globally, leaving health care services at the system and population levels challenged to deliver sustainable and effective interventions to decrease associated mortality and morbidity [ 6 , 7 ].…”

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes

“…We conducted and analyzed data from 97 interviews among 65 participants; some of the same individuals were interviewed in more than one site visit (see Table 1; Lewis, Williams, et al, 2014). See Lewis, Williams, et al (2014) for a detailed description of our data collection procedures. This research was reviewed and approved by the RTI International institutional review board.…”

“…Framework analysis provides a systematic, five-stage approach to organizing and analyzing qualitative data. Table 2 summarizes these five stages and their application to this evaluation (Lewis, Williams, et al, 2014). …”

Cross-Site Evaluation of the Alliance to Reduce Disparities in Diabetes

“…The demographic variables for all program participants are reported elsewhere (see Table 3 of Lewis et al, 2014). The 1,827 program participants with baseline and follow-up data included African Americans (37%), Hispanics (48%), Native Americans (5%), Asians/Pacific Islanders (1%), and other/mixed race (1%).…”