Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights

Kwan, Bethany M.; Jortberg, Bonnie T.; Warman, Meredith K.; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas P.; Martínez, V. J.; Nease, Donald E.

doi:10.1093/fampra/cmw127

Cited by 23 publications

(30 citation statements)

References 27 publications

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“…A key conclusion of the systematic review was the lack of evidence for which SMA features are most effective for improving outcomes important to patients and practices. Upon engaging primary care practices, diabetes patients and family members, and representatives from community health organizations in research prioritization [22], our stakeholders endorsed testing professionally led group visits using a curriculum that addressed both physical and mental health aspects of managing diabetes. The stakeholders wanted evidence on several key SMA features, including the relative value of behavioral health providers as members of a multidisciplinary care team delivering SMAs, standardizing educational topics versus supporting patient choice of topics and topic order, and including diabetes peer mentors [22] to support patients during and outside of group sessions.…”

Section: Introductionmentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

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Background: Shared medical appointments (SMAs) have been shown to be an efficient and effective strategy for providing diabetes self-management education and self-management support. SMA features vary and it is not known which features are most effective for different patients and practice settings. The Invested in Diabetes study tests the comparative effectiveness of SMAs with and without multidisciplinary care teams and patient topic choice for improving patient-centered and clinical outcomes related to diabetes. Methods: This study compares the effectiveness of two SMA approaches using the Targeted Training for Illness Management (TTIM) curriculum. Standardized SMAs are led by a health educator with a set order of TTIM topics. Patient-driven SMAs are delivered collaboratively by a multidisciplinary care team (health educator, medical provider, behavioral health provider, and a peer mentor); patients select the order and emphasis on TTIM topics. Invested in Diabetes is a cluster randomized pragmatic trial involving approximately 1440 adult patients with type 2 diabetes. Twenty primary care practices will be randomly assigned to either standardized or patient-driven SMAs. A mixed-methods evaluation will include quantitative (practice-and patient-level data) and qualitative (practice and patient interviews, observation) components. The primary patient-centered outcome is diabetes distress. Secondary outcomes include autonomy support, self-management behaviors, clinical outcomes, patient reach, and practicelevel value and sustainability. Discussion: Practice and patient stakeholder input guided protocol development for this pragmatic trial comparing SMA approaches. Implementation strategies from the enhanced Replicating Effective Programs framework will help ensure practices maintain fidelity to intervention protocols while tailoring workflows to their settings. Invested in Diabetes will contribute to the literature on chronic illness management and implementation science using the RE-AIM model.

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Section: Introductionmentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

View full text Add to dashboard Cite

show abstract

“…A stakeholder was defined as, "an individual [or group] who is responsible for or affected by health-or healthcarerelated decisions that can be informed by [research] evidence" [22] . Engagement of stakeholder perspectives facilitates shared relationships that can result in long-term partnerships [23] .…”

Section: Design and Methodsmentioning

confidence: 99%

Engaging older adults to inform diabetes medication adherence mobile application selection

Conway¹,

Kelechi²,

Nemeth³

2018

har

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Background: Medication nonadherence is a significant health concern that disproportionately affects older adults. Aging is often associated with comorbidities including diabetes and more complex drug regimens that can impact compliance. Objectives: To explore smartphone use among older adults with diabetes to evaluate potential medication adherence application preferences. Methods: This case report describes a series of stakeholder-engaged discussions with 11 older adults ages 60 years and older and 4 health care providers (HCPs), from a rural and small metropolitan community, in the southeastern United States. The Technology Acceptance Model led a conversation guide. Results: Older adults had smartphone devices. When considering use of the 2 applications, older adults and HCPs indicated preference for the Medisafe application. Conclusions: On the basis of advice of an older adult and HCP stakeholder sample, plans are underway to select a medication adherence application for future research.

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“…30,31 The BCT objective was to identify preferences about DSME/S in primary care. 32 Based on BCT, the study team (including patient stakeholders) identified TTIM as an evidenced-based DSME/S curriculum that fit stakeholder preferences for addressing concurrent medical and mental health needs. The TTIM version selected for Invested in Diabetes was developed for diabetes and co-occurring serious mental illness.…”

Section: Preconditions Phasementioning

confidence: 99%

Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR)

et al. 2020

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Introduction: Complex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context. Methods: The Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices. Results: Practices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients. Conclusion: Enhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions.

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Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights

Cited by 23 publications

References 27 publications

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Engaging older adults to inform diabetes medication adherence mobile application selection

Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR)

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