Peer‐led diabetes self‐management programme for community‐dwelling older people in China: study protocol for a quasi‐experimental design

Aim. A protocol for a new peer‐led self‐management programme for community‐dwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self‐management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi‐experimental. Methods. This study is a non‐equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self‐efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self‐efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self‐efficacy, social support, self‐management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory‐based programme tailored to Chinese patients has potential for improving diabetes self‐management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.     

Effectiveness of a community‐based diabetes self‐management intervention for Chinese adults with type 2 diabetes: A pilot study

This pilot study examined the effects of an intervention on diabetes knowledge and self‐management among adults with type 2 diabetes in Wuhan, China. A convenience sample of 29 adults with type 2 diabetes participated in a 6‐week diabetes intervention in a community health center. Data on diabetes knowledge, diabetes self‐management, fasting blood glucose level, blood pressure, body mass index and waist circumference were collected pre‐ and postintervention and at 1‐month follow‐up. The level of diabetes knowledge was significantly greater postintervention, increasing from a score of 12.97 (± 4.04) to 17.14 (± 3.00) and remaining at 17.03 (± 2.23) at 1‐month follow‐up; Significant improvements in self‐monitoring of blood glucose and medication adherence were not found after the intervention. However, fasting blood glucose levels showed a significant decrease from baseline to postintervention and 1‐month follow‐up. Diabetes self‐management education was thus an effective way to improve diabetes self‐care in this Chinese sample.     

Using intervention mapping to design a self‐management programme for older people with chronic conditions

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.     

New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

Applying the self‐determination theory to develop a school‐to‐work peer mentoring programme to promote social inclusion

Social inclusion of individuals with intellectual and developmental disabilities (IDD) is related to positive mental health and social outcomes; yet, individuals with IDD experience societal barriers that limit opportunities for community participation. Providing opportunities for interactions between individuals with and without IDD through peer mentoring may diminish barriers and improve community inclusion. Guided by the self‐determination theory, the current report describes the development of a peer mentoring programme to promote the natural process of building intrinsic motivation and personal growth through opportunities for individuals without disabilities to socialize with individuals with IDD on a large university campus and throughout the surrounding community. The theoretical framework that informed the development of the peer mentoring programme is described, as well as the participants, the setting in which the programme is situated, the structure of the programme, the initial impacts and improvement of the programme over time, including approaches to sustainability, and implications for future research and practice.     

The role of intrinsic motivation in a group of low vision patients participating in a self‐management programme to enhance self‐efficacy and quality of life

Self‐management programmes have previously been found to decrease health problems, enhance quality of life and increase independence. However, there is no literature that examines the influence of the participants' intrinsic motivation on the outcomes of such programmes. This study examined the role of intrinsic motivation in a pilot low vision self‐management programme to enhance self‐efficacy and quality of life of the programme participants. A positive association was observed between the female participants' perceived choice and perceived competence, two underlying dimensions of the Intrinsic Motivation Inventory. In addition, a positive correlation was observed between the younger participants' perceived competence and the change in their quality of life. The findings provide some support for consideration of participants' intrinsic motivation in the development of effective self‐management programmes.