scholarly journals The Process Evaluation of a Comparative Controlled Trial to Support Self-management for the Prevention and Management of Type 2 Diabetes in Uganda, South Africa and Sweden in the SMART2D Project.

2021 ◽  
Author(s):  
Josefien van Olmen ◽  
Pilvikki Absetz ◽  
Roy William Mayega ◽  
Linda Timm ◽  
Peter Delobelle ◽  
...  
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Peer Support ◽  
Organizational Context ◽  
Implementation Process ◽  
Community Support ◽  
Self Management ◽  
Use Of Resources ◽  
Process Evaluations

Abstract Background. Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory, implementation and context. The SMART2D project implemented and evaluated community-based support interventions for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socio-economically disadvantaged urban communities in Sweden. This study presents comprehensive analyses of the implementation process and interaction with context. Methods. This paper reports implementation process outcomes across the three sites, guided by the MRC framework for complex intervention process evaluations and focusing on the three community strategies (peer support program; care companion; and link between facility care and community support). Data were collected through observations of peer support group meetings using a structured guide, and semi-structured interviews with project managers, implementers and participants. Results. The countries focused their in-depth implementation in accordance with the feasibility and relevance in the context. In Uganda and Sweden, the implementation focused on the peer support intervention whereas in South Africa, it centred around the CC part. The community-facility link received the least attention in the implementation. Continuous capacity building received a lot of attention, but intervention reach, dose delivered and fidelity varied substantially. Intervention- and context-related barriers affected participation. The analysis revealed how context shaped the possibilities of implementation, the delivery and participation and affected the mechanism of impact. Conclusions. Identification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and a flexibility in evaluation design to adapt to the complex nature of the intervention. When designing an intervention, it is crucial to consider aspects of the implementing organization or structure, absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale up. Trial registration. ISRCTN 11913581 (Registration 1/10/2017, https://doi.org/10.1186/ISRCTN11913581)

scholarly journals The process evaluation of a pragmatic implementation trial to support self-management for the prevention and management of type 2 diabetes in Uganda, South Africa and Sweden in the SMART2D project

2021 ◽  
Author(s):  
Josefien van Olmen ◽  
Pilvikki Absetz ◽  
Roy William Mayega ◽  
Linda Timm ◽  
Peter Delobelle ◽  
...  
Keyword(s):  
South Africa ◽  
Peer Support ◽  
Organizational Context ◽  
Implementation Process ◽  
Community Support ◽  
Self Management ◽  
Complex Nature ◽  
Structured Interviews ◽  
Use Of Resources ◽  
Process Evaluations

Abstract BackgroundType 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory, implementation and context. The SMART2D project implemented and evaluated community-based support interventions for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socio-economically disadvantaged urban communities in Sweden. This study presents comprehensive analyses of the implementation process and interaction with context.MethodsThis paper reports implementation process outcomes across the three sites, guided by the MRC framework for complex intervention process evaluations and focusing on the three community strategies (peer support program; care companion; and link between facility care and community support). Data were collected through observations of peer support group meetings using a structured guide, and semi-structured interviews with project managers, implementers and participants.ResultsThe countries focused their in-depth implementation in accordance with the feasibility and relevance in the context. In Uganda and Sweden, the implementation focused on the peer support intervention whereas in South Africa, it centred around the CC part. The community-facility link received the least attention in the implementation. Continuous capacity building received a lot of attention, but intervention reach, dose delivered and fidelity varied substantially. Intervention- and context-related barriers affected participation. The analysis revealed how context shaped the possibilities of implementation, the delivery and participation and affected the mechanism of impact.ConclusionsIdentification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and a flexibility in evaluation design to adapt to the complex nature of the intervention. When designing an intervention, it is crucial to consider aspects of the implementing organization or structure, absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale up.Trial registrationISRCTN 11913581 (Registration 1/10/2017, https://doi.org/10.1186/ISRCTN11913581)

scholarly journals SMART2D—development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden

2020 ◽  
Vol 10 (1) ◽  
pp. 25-34
Author(s):  
Pilvikki Absetz ◽  
Josefien Van Olmen ◽  
David Guwatudde ◽  
Thandi Puoane ◽  
Helle Mölsted Alvesson ◽  
...  
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Community Support ◽  
Self Management ◽  
Local Context ◽  
Situational Analysis ◽  
Socioeconomically Disadvantaged ◽  
Increased Risk ◽  
Community Strategies

Abstract Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.

Putting Self-Management in the Context of Community-Dwelling American Indians Living With Type 2 Diabetes

2019 ◽  
Vol 46 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Jacqueline Jones ◽  
R. Turner Goins ◽  
Mark Schure ◽  
Blythe Winchester ◽  
Vickie Bradley
Keyword(s):  
Type 2 Diabetes ◽  
American Indians ◽  
Management Education ◽  
Self Care ◽  
Community Support ◽  
Community Dwelling ◽  
National Standards ◽  
Self Management ◽  
Community Food Security

Purpose The purpose of this qualitative descriptive study was to examine the National Standards for Diabetes Self-Management Education and Support (DSMES) defined diabetes self-care behaviors (healthy eating, being active, taking medication, monitoring, problem solving, reducing risk, and healthy coping) in the context of older community-dwelling American Indians (AIs). Methods Secondary theme analysis of transcribed semistructured qualitative interview data from 28 participants in the Native Elder Care Study aged >60 years identified factors that influence the DSMES self-care behaviors in the context of community-dwelling AIs. Results Four themes that characterized barriers, facilitators, and opportunities for DSMES to support self-care behaviors included community food security, care partners in self-care, community opportunities for diabetes support, and blending of both health worlds. Conclusion Tribal communities have contemporary strengths and cultural traditions that can be activated to enhance diabetes self-management education and support. Diabetes educators can work in tandem with community health representatives to strengthen the social and community support within which individual AIs with type 2 diabetes mellitus live. Community-based participatory research with AI caregivers, dyads, families, youth, and Indian Health Service clinicians may help to improve tribal food policy and school health initiatives, as well as develop intergenerational interventions for modeling effective diabetes self-management.

scholarly journals Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation

2021 ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background: Despite increasing use and positive effects of peer support interventions, little is known about how they produce outcomes. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating how the peers interacted in the intervention, we further examined how peers’ individual contextual factors facilitated or hindered the mechanisms in operation. Methods: We used a multi-method case-study design (n=9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager and a diabetes nurse) for each case (n=25). Furthermore, we collected survey data from peers both before and after participation (n=9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results: We identified two groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions: We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration : ClinicalTrials.gov, Retrospective Registration (01/20/2021), registration number NCT04722289, https://clinicaltrials.gov/ct2/show/NCT04722289?term=The+Together+on+Diabetes+Intervention+-+a+Realist+Evaluation%2C&draw=2&rank=1 Keywords: Complex Intervention, Realist evaluation, Mechanisms, Context, Peer support, Diabetes self-management, Healthcare services, Inequality

scholarly journals Understanding the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes: a realist evaluation

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background Despite an increasing use and positive effects of peer support interventions, little is known about how the outcomes are produced. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating the participating peers’ interactions, we furthermore examined how their individual contextual factors either facilitated or hindered the mechanisms in operation. Methods We used a multi-method case-study design (n = 9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager, and a diabetes nurse) for each case (n = 25). Furthermore, we collected survey data from peers both before and after participation (n = 9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis. Results We identified 2 groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes. Trial registration ClinicalTrials.gov, Retrospective Registration (20 Jan 2021), registration number NCT04722289.

scholarly journals Understanding the Mechanisms Generating Outcomes in a Danish Peer support Intervention for Socially Vulnerable People with type 2-Diabetes: A Realist Evaluation

2021 ◽  
Author(s):  
Stine Dandanell Garn ◽  
Charlotte Glümer ◽  
Sarah Fredsted Villadsen ◽  
Gritt Marie Hviid Malling ◽  
Ulla Christensen
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Self Management ◽  
Support Intervention ◽  
Vulnerable People ◽  
Peer Support Intervention

Abstract Background: Despite increasing use and positive effects of peer support interventions, little is known about how they produce outcomes. Thus, it is essential not only to measure outcomes, but also to identify the mechanisms by which they are generated. Using a realist evaluation approach, we aimed to identify the mechanisms generating outcomes in a Danish peer support intervention for socially vulnerable people with type 2-diabetes (peers). By investigating how the peers interacted in the intervention, we further examined how peers’ individual contextual factors facilitated or hindered the mechanisms in operation.Methods: We used a multi-method case-study design (n=9). Data included semi-structured interviews with four key groups of informants (peer, peer supporter, project manager and a diabetes nurse) for each case (n=25). Furthermore, we collected survey data from peers both before and after participation (n=9). The interview data were analysed using a systematic text condensation, and the Intervention-context-actor-mechanism-outcome framework was used to structure the analysis.Results: We identified two groups of mechanisms that improved diabetes self-management and the use of healthcare services (outcomes): ‘perceived needs and readiness’ and ‘encouragement and energy’. However, the mechanisms only generated the intended outcomes among peers with a stable occupation and financial situation, a relatively good health condition, and sufficient energy (all defined as contextual factors). Independent of these contextual factors, ‘experience of social and emotional support’ was identified as a mechanism within all peers that increased self-care awareness (defined as output). Dependent on whether the contextual factors facilitated or hindered the mechanisms to generate outcomes, we categorised the peers into those who achieved outcomes and those who did not. Conclusions: We identified two groups of mechanisms that improved the peers’ diabetes self-management and use of healthcare services. The mechanisms only generated the intended outcomes if peers’ individual contextual factors facilitated an active interaction with the elements of the intervention. However, independent of these contextual factors, a third group of mechanisms increased self-care awareness among all peers. We highlight the importance of contextual awareness of the target groups in the design and evaluation of peer support interventions for socially vulnerable people with type 2-diabetes.Trial registration: ClinicalTrials.gov, Retrospective Registration (01/20/2021), registration number NCT04722289, https://clinicaltrials.gov/ct2/show/NCT04722289?term=The+Together+on+Diabetes+Intervention+-+a+Realist+Evaluation%2C&draw=2&rank=1

scholarly journals Self-management in face-to-face peer support for adults with type 2 diabetes living in low- or middle-income countries: a systematic review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Melanie Pienaar ◽  
Marianne Reid
Keyword(s):  
Type 2 Diabetes ◽  
Peer Support ◽  
Health Workers ◽  
Self Management ◽  
Diabetic Patients ◽  
Reference List ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries

Abstract Background Peer support has been recognised as a promising strategy to improve self-management in patients living with chronic conditions, such as Type 2 diabetes (T2D). The purpose of the review was to synthesise the best available evidence on face-to-face peer support models for adults with T2D in low and middle-income countries (LMICs). Methods We searched Medline, Cumulative Index to Nursing and Allied Health, Literature Academic Search Ultimate, PsycINFO, CAB Abstracts, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, SocINDEX, ERIC, PsycARTICLES, Open Dissertations, Communication & Mass Media Complete, Health Source-Consumer Edition and Google Scholar for the period January 2000 to December 2017. Reference list checking and contact with authors were additional sources of data. Screening of papers, critical appraisal and data extraction were carried out independently by at least two reviewers. Results From 3092 abstracts retrieved from database searches, data was extracted from 12 papers. There was no consistency in design, setting, outcomes or measurement instruments amongst the papers. The papers were associated with improvements in various clinical and behavioural outcomes. Diabetic patients and community health workers (CHWs) were identified as two common face-to-face peer support models. The recruitment and selection of diabetic patients as peer supporters focused on patients from the community, with good glycaemic control and/or leadership skills, who were recommended by healthcare professionals. Recruitment of CHWs as peer supporters was done from an existing infrastructure of CHWs in the community and, thus, selection criteria were poorly described. The training of peer supporters featured as an important component, highlighting who provided training and the duration and content covered in training. Motivational interviewing was the most common theory basis of training used in the peer support interventions. Face-to-face, group and/or individual-based peer support was often supplemented by other peer support methods. The supervision of peer supporters was generally poorly described. Conclusions The comprehensive synthesis of the best available evidence has led to new insights regarding face-to-face peer support as a self-management strategy for patients with T2D in LMICs. Face-to-face peer support may be implemented in innovative ways to improve the quality of life of patients with T2D. Trial registration PROSPERO trial registry number, CRD 42018103261.

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