Senior researcher Communication in Healthcare
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Publication date
Improving self-management of people with type 2 diabetes in the first years after diagnosis: development and pilot of a theory-based interactive group intervention.
Puffelen, A.L. van, Heijmans, M.J.W.M., Schellevis, F., Nijpels, G., Rijken, M. Improving self-management of people with type 2 diabetes in the first years after diagnosis: development and pilot of a theory-based interactive group intervention. SAGE Open Medicine: 2019, 7(2050312119)
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Objective
This study aims to explore the contribution of implicit attitudes and associations towards conventional disease-modifying antirheumatic drugs (cDMARDs), alongside explicit measures, on medication-taking behaviour and clinical outcomes in adult patients with rheumatoid arthritis (RA).
Methods
In this observational study, implicit attitudes (positive-negative) and health-related associations (health-sickness) were measured with Single Category Implicit Association Tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs about Medicines Questionnaire Specific. The primary outcome of this study was medication-taking behaviour subjectively measured by self-report (i.e. validated Compliance Questionnaire on Rheumatology) and objectively measured with electronic drug monitors over a 3 month period. Spearman rank correlations were used to describe correlations between implicit and explicit outcomes. Nested linear regression models were used to assess the additional value of implicit measures over explicit measures and patient-, clinical-, and treatment-related characteristics.
Results
Of the 1659 initially-invited patients, 254 patients with RA agreed to participate in this study. Implicit attitudes correlated significantly with necessity-concerns differential (NCD) scores (ρ = 0.13, P = 0.05) and disease activity scores (ρ = -0.17, P = 0.04), whereas implicit health-related associations correlated significantly with mean scores for explicitly reported health-related associations (ρ = 0.18, P = 0.004). Significant differences in age, number of DMARDs, biologic DMARD use, NCD-scores, and self-reported correct dosing were found between the four attitudinal profiles. Nested linear regression models revealed no additional value of implicit measures in explaining self-reported medication-taking behaviour and clinical outcomes, over and above all other variables.
Conclusion
Implicit attitudes and associations had no additional value in explaining medication-taking behaviour and clinical outcomes over and above often used explicitly measured characteristics, attitudes and outcomes in the studied population. Only age and NCD scores contributed significantly when the dependent variable was correct dosing measured with self-report.
This study aims to explore the contribution of implicit attitudes and associations towards conventional disease-modifying antirheumatic drugs (cDMARDs), alongside explicit measures, on medication-taking behaviour and clinical outcomes in adult patients with rheumatoid arthritis (RA).
Methods
In this observational study, implicit attitudes (positive-negative) and health-related associations (health-sickness) were measured with Single Category Implicit Association Tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs about Medicines Questionnaire Specific. The primary outcome of this study was medication-taking behaviour subjectively measured by self-report (i.e. validated Compliance Questionnaire on Rheumatology) and objectively measured with electronic drug monitors over a 3 month period. Spearman rank correlations were used to describe correlations between implicit and explicit outcomes. Nested linear regression models were used to assess the additional value of implicit measures over explicit measures and patient-, clinical-, and treatment-related characteristics.
Results
Of the 1659 initially-invited patients, 254 patients with RA agreed to participate in this study. Implicit attitudes correlated significantly with necessity-concerns differential (NCD) scores (ρ = 0.13, P = 0.05) and disease activity scores (ρ = -0.17, P = 0.04), whereas implicit health-related associations correlated significantly with mean scores for explicitly reported health-related associations (ρ = 0.18, P = 0.004). Significant differences in age, number of DMARDs, biologic DMARD use, NCD-scores, and self-reported correct dosing were found between the four attitudinal profiles. Nested linear regression models revealed no additional value of implicit measures in explaining self-reported medication-taking behaviour and clinical outcomes, over and above all other variables.
Conclusion
Implicit attitudes and associations had no additional value in explaining medication-taking behaviour and clinical outcomes over and above often used explicitly measured characteristics, attitudes and outcomes in the studied population. Only age and NCD scores contributed significantly when the dependent variable was correct dosing measured with self-report.
Objectives
To describe how principles of self-regulation and social support could be integrated in a group intervention to improve self-management of people with type 2 diabetes mellitus in the early phase of illness and to pilot its suitability in a primary care setting.
Methods
Principles of the Common-Sense Model of Self-Regulation, Social Cognitive Theory of Self-Regulation and social support theories were integrated in the intervention. Based on this, a three-session group course was developed to challenge illness perceptions of participants that discourage adequate self-management, to practice goal-setting and behavioural actions and to create a supportive environment. The intervention was piloted with persons with early-stage (1–3 years post diagnosis) type 2 diabetes mellitus selected in general practice in the Netherlands. Data about the suitability of the intervention were retrieved by means of observation and audio-recording of the sessions, an evaluation form filled in by the participants and an evaluation meeting with the group leaders.
Results
In total, 16 type 2 diabetes mellitus patients participated in the pilot, who were divided into a group of single participants (N = 8) and a group (N = 8) who participated with their partner. Discrepancies between perceptions of one’s own condition and type 2 diabetes mellitus in general were observed. Goal-setting and developing action plans appeared to be difficult tasks for many participants, whereas others felt these exercises were not useful as they did not feel a need to make changes in living with diabetes. The group-based format was appreciated as was the participation of partners.
Conclusion
Challenging the illness perceptions of persons with early-stage type 2 diabetes mellitus by a brief interactive group course is feasible and important, as many of these people tend to underestimate the seriousness of their diabetes. However, motivating persons with early-stage type 2 diabetes mellitus to participate in self-management interventions remains a challenge. Offering the intervention as an integral part of type 2 diabetes mellitus management in primary care is desirable.
To describe how principles of self-regulation and social support could be integrated in a group intervention to improve self-management of people with type 2 diabetes mellitus in the early phase of illness and to pilot its suitability in a primary care setting.
Methods
Principles of the Common-Sense Model of Self-Regulation, Social Cognitive Theory of Self-Regulation and social support theories were integrated in the intervention. Based on this, a three-session group course was developed to challenge illness perceptions of participants that discourage adequate self-management, to practice goal-setting and behavioural actions and to create a supportive environment. The intervention was piloted with persons with early-stage (1–3 years post diagnosis) type 2 diabetes mellitus selected in general practice in the Netherlands. Data about the suitability of the intervention were retrieved by means of observation and audio-recording of the sessions, an evaluation form filled in by the participants and an evaluation meeting with the group leaders.
Results
In total, 16 type 2 diabetes mellitus patients participated in the pilot, who were divided into a group of single participants (N = 8) and a group (N = 8) who participated with their partner. Discrepancies between perceptions of one’s own condition and type 2 diabetes mellitus in general were observed. Goal-setting and developing action plans appeared to be difficult tasks for many participants, whereas others felt these exercises were not useful as they did not feel a need to make changes in living with diabetes. The group-based format was appreciated as was the participation of partners.
Conclusion
Challenging the illness perceptions of persons with early-stage type 2 diabetes mellitus by a brief interactive group course is feasible and important, as many of these people tend to underestimate the seriousness of their diabetes. However, motivating persons with early-stage type 2 diabetes mellitus to participate in self-management interventions remains a challenge. Offering the intervention as an integral part of type 2 diabetes mellitus management in primary care is desirable.
