Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 2, 2024
Date Accepted: Aug 21, 2024
Date Submitted to PubMed: Sep 6, 2024
An evidence-based nurse-led intervention to reduce diabetes distress among adults with type 1 diabetes and diabetes distress (REDUCE): Development of a complex intervention informed by the Medical Research Council framework
ABSTRACT
Background:
Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes and is occurring in more than 40 % of adults with type 1 diabetes. However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care.
Objective:
To modify and adapt existing, evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with type 1 diabetes and moderate to severe diabetes distress.
Methods:
This study took place at two specialised diabetes centres in Denmark from November 2019 to June 2021. A total of 36 adults with type 1 diabetes participated in 10 parallel workshops. Twelve diabetes-specialised nurses were interviewed and participated in one co-creation workshop and 12 multidisciplinary specialists (psychologists, educational specialists, and researchers) participated in four co-creation workshops and 14 feedback meetings. Data were analysed by applying a deductive analytical approach.
Results:
The intervention included five bi-weekly 2½-hour small group sessions with adults with type 1 diabetes and diabetes distress delivered by two trained diabetes specialist nurses from a detailed manual with descriptions and step-by-step guidance. The intervention material includes visual conversation tools, covering seven diabetes-specific sources derived from the 28-item diabetes distress scale for measuring diabetes distress: 1) powerlessness, 2) self-management, 3) fear of hypoglycaemia, 4) food and eating, 5) friends and family, 6) negative social perception, and 7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections as well as plenary- and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries, and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention nurses needed increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills.
Conclusions:
This co-design study has described the adaption of a complex intervention with a strong evidence base including detailed reporting of the theoretical underpinnings and core mechanisms. Clinical Trial: N/A
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