Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 11, 2019
Date Accepted: Dec 16, 2019
Integrating self-management needs and theory to implement a web-based self-management tool for people with Type 1 diabetes using an insulin pump
ABSTRACT
Background:
Type 1 diabetes (T1D) is an autoimmune disease requiring intensive self-management (SM). An insulin pump (a new health technology) is designed to better support personal T1D management but at the same time exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social-support and resources from online interventions which offer flexible, innovative and accessible SM. However, questions remain as to which behaviour change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions from both patients and healthcare professionals (HCPs).
Objective:
The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist HCPs pertaining to a web-based social network (SN) intervention to support SM and determine what behaviour change characteristics and strategies are required.
Methods:
Focus Groups with insulin pump users (N=19) and specialist HCPs (N=20) in 6 NHS Trusts across the South of England examined the barriers and enablers to incorporating and self-managing an insulin pump. Analysis was undertaken using the Behaviour Change Wheel and Theoretical Domains Framework followed by a taxonomy of Behaviour Change Techniques (BCTs) to identify the contents of and strategies for implementation of a complex health intervention.
Results:
Four themes represent the SM perspectives and experiences of stakeholders: (1). A desire for access to tailored and appropriate resources and information - the support and information required for successful SM is situational, contextual and varies according to time and life circumstances and so needs to be tailored and appropriate; (2). Specific social-support preferences - taking away isolation, providing shared learnings and practical tips, but limitations included the fear of judgement from others and self-pity from peers; (3). The environmental context: Capacity and knowledge of pump clinic HCPs - HCPs acknowledge patient’s need for holistic support but lack confidence in providing it; and (4). Professional responsibility: “Risks and dangers” – HCPs are bombarded with “risks and dangers” around SM support for patients and question whether it fits into their role. BCTs were identified to address these issues.
Conclusions:
The use of a behavioural theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers to and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complimenting NHS services. However in order for intervention implementation, HCP apprehensions about responsibility when signposting to outside agencies or support would need to be addressed, and opportunistic features added where pump users could actively engage with other people living with T1D.
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