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Understanding the influences on participation in a National Diabetes Prevention Programme and developing an implementation strategy to improve referral
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Date
2024
Authors
Haseldine, Clair
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Background
Type 2 diabetes is a growing global health priority. Diabetes Prevention Programmes (DPPs) can prevent or delay the progression to type 2 diabetes for those at high risk. Referral to and participation in DPPs has been low. Ireland is implementing a National Diabetes Prevention Programme (NDPP) providing an opportunity to understand the early implementation of a national programme which was developed and delivered initially online.
Aim
To understand barriers and facilitators to referral and participation at the early implementation stage of an online NDPP in Ireland, to inform the development of a strategy to enhance referral to the programme in the future.
Methods
Multiple methods were used within the Behaviour Change Wheel (BCW), a framework which follows a staged approach to designing a behaviour change strategy. A quantitative postal survey of characteristics of people who attended the NDPP pilot, facilitated recruitment to remote qualitative interviews or focus groups with attenders and educators, analysed using the Theoretical Domains Framework (TDF). A mixed methods systematic review explored healthcare worker’s (HCWs) perspectives on referral to diabetes prevention programmes (DPPs) using a best-fit framework synthesis method with the TDF. Findings from the qualitative survey and systematic review informed an online modified Delphi survey with healthcare professionals (GPs, practice nurses, educators) employed to prioritise factors affecting referral to the NDPP. Using the BCW, the prioritised factors were mapped to Behaviour Change Techniques (BCTs) to include in a strategy.
Results
The postal survey had a response rate of 30.5 % (n=22). Two groups that are considered harder to reach in DPPs, men (57.1% n=12) and people of working age (mean age 62 years), were well represented. Respondents (attenders of the programme) understood that type 2 diabetes was a serious disease, that they were at risk of developing it and participating in the NDPP could reduce that risk .
Thirteen attenders and all eight educators who were delivering the NDPP pilot during the study period took part in the qualitative interview study. Three themes were identified relating to factors influencing participation in the NDPP: a lack of awareness of prediabetes and fear of diabetes prior to attending the programme, perceived need for programme support to change health behaviour and trust in healthcare professionals to convey the seriousness of the diagnosis. One further theme practical and personal ease of joining online, related to factors pertaining to the synchronous online context: flexibility and accessibility of the online format, the IT skills of attenders and educators and the privacy and decreased apprehension of joining a group online in comparison to a face-to-face group.
In the systematic review of healthcare workers’(HCWs) perspectives to barriers and facilitators to referral to DPPs, thirty-seven papers met the inclusion criteria . Barriers and facilitators were coded to 11 of the 14 TDF domains and to another category “Expectation of Patient Barriers”. HCWs highlighted the need for clear referral pathways and additional resources to improve referrals. They were concerned about the potential (time and financial) burden on patients of attending the DPP, leading them to have conflicted feelings about referring. Additionally, HCWs lacked knowledge about the effectiveness, availability, and accessibility of DPPs.
In the Delphi survey, of 21 factors affecting referral, 12 reached consensus as being of high/very high importance to address. Using BCW guidance, these factors mapped to nine BCTs which were appropriate for the Irish healthcare context. The suggested strategy to support referrals should include education for referrers delivered by educators (fellow healthcare professionals), educational materials and practical support. The health service should continue to support electronic referrals to the programme and electronic prompts to refer could be considered.
Conclusions
Using behavioural science frameworks this PhD thesis incorporated stakeholder input to identify the barriers and facilitators to early implementation of a NDPP and generated the content for an implementation strategy to improve referral. The findings suggest the health service should continue to offer an online DPP, support electronic referrals and consider electronic prompts for referral.
Description
Keywords
Implementation science , Diabetes prevention programme
Citation
Haseldine, C. 2024. Understanding the influences on participation in a National Diabetes Prevention Programme and developing an implementation strategy to improve referral. PhD Thesis, University College Cork.