Barriers and enablers to sustaining self-management behaviours after completing a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following completion of a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

Midwives’ Survey of Their Weight Management Practice Before and After the GLOWING Guideline Implementation Intervention: A Pilot Cluster Randomised Controlled Trial

Background: Weight management is a priority for maternity services due to pregnancy risks and long-term health implications for women and babies. Pregnancy interventions significantly improve maternal diet, physical activity, weight, and some pregnancy outcomes. There are complex barriers, underpinned by self-efficacy, to midwives’ implementation of UK guidelines. The GLOWING intervention uses social cognitive theory (SCT) to address evidence-based barriers to practice, with the aim of supporting midwives’ implementation of guidelines into routine practice.Methods: An external rehearsal pilot cluster randomised controlled trial in four NHS Trusts (clusters) in England, UK. Clusters were randomised to intervention arm where all eligible midwives received the intervention, or control arm which received no intervention. A random sample of 100 midwives were invited to complete questionnaires pre- and post-intervention. UK guideline recommendations were grouped into communication-related behaviours (weight and risk communication) and support/intervention-related behaviours (diet/nutrition, physical activity, weight management, referrals/signposting). Questionnaires were developed using SCT constructs (self-efficacy, outcome expectancies, intentions, behaviours) and 7-point Likert scale. Data were converted to a 0-100 scale, where higher scores were more positive. Descriptive statistics compared intervention and control arms, pre- and post-intervention.Results: Seventy-four midwives consented and 68 returned questionnaires. Pre-intervention, self-efficacy for support/intervention-related behaviours scored lowest. In the control arm, there was limited difference between the pre- and post-intervention scores. Post-intervention, the mean scores were consistently higher in the intervention than control arm, particularly for support/intervention self-efficacy (71.4, SD 17.1 and 58.4, SD 20.1). Mean self-efficacy was higher post-intervention than pre-intervention for all behaviour categories in the intervention arm: weight communication (76.3, SD 16.7 vs. 67.2, SD 21.1), risk communication (79.4, SD 16.4, vs. 68.6, SD 14.9), diet/nutrition/physical activity (76.4, SD 16.0 vs. 49.3, SD 16.5), weight management (72.1, SD 18.3 vs. 48.3, SD 19.8), referrals/signposting (63.3, SD 26.0 vs. 47.9, SD 17.3), and consistently higher than controls.Conclusions: This study supports the theoretical models used to develop GLOWING, particularly that low self-efficacy is core to implementation barriers. Results suggest that the intervention is successfully targeting self-efficacy, which could have a positive impact on guideline implementation. A future definitive trial is required to determine effectiveness and cost-effectiveness. Trial registration: ISRCTN46869894, retrospectively registered 25/05/2016, http://isrctn.com/ISRCTN46869894

HIV Education, Empathy, and Empowerment (HIVE3): A Peer Support Intervention for Reducing Intersectional Stigma as a Barrier to HIV Testing among Men Who Have Sex with Men in Ghana

Men who have sex with men (MSM) in Ghana remain at heightened risk of HIV infection, and face challenges in accessing HIV prevention and care services. Previous research in Ghana shows that MSM face intersectional stigma across ecological levels (family, peers, healthcare settings, and community level) and the criminalization of same-gender sexual behaviors in the country. To protect their wellbeing from exposure to stigma, many MSM avoid interactions with healthcare systems and services, which inadvertently inhibits their opportunities for early detection and treatment of HIV. Consequently, MSM in Ghana carry a disproportionate burden of HIV prevalence (18%) compared to the general population (2%), highlighting the need for culturally relevant processes in HIV/STI prevention, and care communication to optimize sexual health and wellness among MSM in Ghana. To this effect, we collaborated with community partners to use the Assessment, Decision, Adaptation, Production, Topical Experts, Training, Testing (ADAPT-ITT) model to modify a theory-driven smartphone-based peer support intervention to enhance its focus on intersectional stigma reduction, and improve HIV health-seeking behaviors among MSM, including HIV testing and linkage to care. We used the Dennis Peer Support Model to develop the peer support components (emotional, informational, and appraisal support) to increase peer social support, decrease social isolation, and minimize intersectional stigma effects on HIV-related healthcare-seeking behaviors. This paper shows the preliminary acceptability and effectiveness of employing culturally relevant techniques and communication strategies to provide secure peer support to improve HIV prevention and care among key populations in highly stigmatized environments.