Paul Gillian, Smith Susan M, Whitford David, O'Kelly Fergus, O'Dowd Tom
Department of Public Health and Primary Care, Trinity College, Dublin 2, Ireland.
BMC Health Serv Res. 2007 Aug 31;7:136. doi: 10.1186/1472-6963-7-136.
Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting.
The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention. The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention.
The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4. Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention.
The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care.
Current Controlled Trials ISRCTN42541690.
糖尿病是一种慢性病，患者需要自行负责自身护理，目标是将血糖和血压水平尽可能维持在接近正常的范围。传统上，糖尿病自我管理培训是在说教式环境中进行的。近年来，人们对传统糖尿病护理方式的替代方法进行了研究，例如同伴支持的概念，该概念强调患者主导而非专业人员主导。本文旨在描述在初级保健环境中为一项随机对照试验而开发的2型糖尿病同伴支持复杂干预措施。
医学研究理事会（MRC）关于随机对照试验（RCT）复杂干预措施开发与评估的框架被用作设计该干预措施的理论指南。深入研究了该框架的前三个阶段（临床前阶段、第1阶段、第2阶段）。临床前阶段包括对与2型糖尿病和同伴支持相关的文献进行综述。在第1阶段，将理论背景与来自4个焦点小组的定性数据相结合，以确定干预措施的主要组成部分。在第2阶段进行了初步干预。这是一项在两家普通诊所对24名患者和4名同伴支持者开展的试点研究。通过焦点小组和半结构化访谈收集了更多定性数据，为干预措施的开发提供信息。
从临床前阶段和第1阶段确定了干预措施的四个组成部分。它们是：1. 同伴支持者；2. 同伴支持者培训；3. 对同伴支持者的保留和支持；4. 同伴支持会议。在第2阶段实施了初步干预措施。该阶段的结果使干预措施能够进一步优化，从而产生最终的干预措施。
MRC框架有助于在初级保健中开发强有力的2型糖尿病同伴支持干预措施。
当前受控试验ISRCTN42541690。
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