Abstract
Background: Self-management education supports people to live with diabetes and is a key element of diabetes care as recommended in national and international guidelines. However, in many countries, fewer than a third of people with type 2 diabetes mellitus (T2DM) participate in self-management education, and many do not receive adequate ongoing support following programme attendance. This unsatisfactory provision of support may suggest that self-management education programmes are insufficiently integrated into the routine care of people with T2DM.Aims: This study explored integration in the context of self-management education programmes for people with T2DM in routine care to explain factors (components and mechanisms) that influence how people with T2DM and healthcare professionals (HCPs) experience and perceive the integration of such programmes at the patient, HCP and system levels.
Methods: Using a qualitative case study design, data of three self-management education programmes from a quality improvement initiative in diabetes care were collected and analysed. In total, 20 people with T2DM and 36 HCPs participated in semi-structured in-depth interviews; 88 hours of direct programme observation were undertaken; and 14 programme documents were reviewed. The data from the different sources were triangulated within a thematic narrative approach and synthesised across cases guided by the perspectives of complex adaptive systems.
Results: The study synthesis revealed components and mechanisms that describe the integration of self-management education into routine care. The identified components of integration were as follows: 1) person-centred care – the way HCPs support individual patients in engaging in self-management behaviour; 2) programme ethos – the approaches with which HCPs apply a theoretical programme framework in practice; 3) inter-professional work – the manner in which HCPs collaborate in delivering self- management education; 4) communal resources – the local structures and processes by which a programme’s context encourages self-management education; and 5) programme regulations – the recommendations and guidelines that standardise self-management education within a system. The mechanisms of integration related to the extent to which patients: 1) identified with their condition and activity; 2) experienced social support; 3) engaged in co-creating their interactions with HCPs; and 4) received self-management support by HCPs who congruently deliver such a care paradigm. The components and mechanisms of integration were observed to interact at and between the levels of people with T2DM, HCPs and the care system. These findings thus made it possible to conceptualise person-centred integrated self-management education as a form of dynamic relationships within interacting systems.
Conclusion: Understanding the context-specific nature of integration emphasises the need for a theory-driven approach. Dynamic relationships and interactions characterise the complexities associated with the integration of self-management education into routine care. Multiple strategies, which may collectively impact the behaviour of both people with T2DM and that of HCPs, are required to create the conditions for self-management behaviour to be developed and sustained in healthcare delivery. This knowledge may inform programme development and care delivery to better integrate self-management education into routine care. Follow-up research may investigate the potential benefits of programmes that incorporate person-centred care delivery with a whole-system approach of self-management support.
| Date of Award | 1 Mar 2019 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Angus Forbes (Supervisor) & Deborah Chinn (Supervisor) |