DEVELOPMENT OF A PROBLEM AND ATTRIBUTES BASED DIABETES SELF-MANAGEMENT (PARADIGM) INTERVENTION

Abstract

Background: Type 2 diabetes mellitus (T2D), is a growing pandemic across the world. T2D requires a comprehensive diabetes self-management (DSM) skills in addition to medications. It is still unclear what interventions can influence intention for DSM and how best these interventions can be delivered. Aim: To critically evaluate structure of existing diabetes self-management interventions and their impact on different levels of outcomes such as knowledge, physical activity, glycated hemoglobin (HbA1c), and quality of life. Understand perception of T2D patients towards intention to DSM and combine findings to develop problem and attribute-based case scenarios that can be integrated in DSM interventions. Method: First, a critical evaluation of the recent interventional studies using a concept analysis to clearly define the operational conceptualization and boundaries of existing diabetes self-management interventions programs and eventually provision of tools for further research. Then meta-regression analysis was conducted to classify existing intervention based on the attributes and evaluate the impact of these attributes on different levels of outcomes. Next, a focus group study to explore perspectives of persons with T2D towards DSM performed, followed by tool development using focus group responses to assess intention towards DSM. Finally, Delphi study included stakeholders in diabetes care was implemented to generate a consensus on case scenarios of attribute and problem-based curriculum for promotion of T2D self-management (PARADIGM). Results: From concept analysis, the operational conceptualization of interventions were redefined into 5 key core attributes (1) decision making, (2) problem solving, (3) taking action, (4) patient-provider interaction and (5) resource utilization. In meta-regression study consisting of 142 papers, skills related attributes were effective on improving knowledge SMD = 0.80 (0.11, 1.49); P = 0.025. Fear of complications and death was motivators for DSM, whereas food and social customs were demotivators for DSM. The tool developed from focus group study was reliable and a good internal consistency to predict intention towards DSM. In the Delphi, we combined previous findings to generate problems and attributes-based DSM intervention using case scenarios. Conclusion: This project outlined the importance of developing a robust DSME intervention program. This could result in increasing uptake by PWD of an effective intervention that can help maintain successful DSM with consequent improvements in their quality of life.