在常规初级保健中系统开发一种基于理论的多方面行为干预措施，以增加2型糖尿病成年人的身体活动：2型糖尿病的运动疗法
Systematic development of a theory-informed multifaceted behavioural intervention to increase physical activity of adults with type 2 diabetes in routine primary care: Movement as Medicine for Type 2 Diabetes.
作者信息
Avery Leah, Charman Sarah J, Taylor Louise, Flynn Darren, Mosely Kylie, Speight Jane, Lievesley Matthew, Taylor Roy, Sniehotta Falko F, Trenell Michael I
机构信息
Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
出版信息
Implement Sci. 2016 Jul 19;11:99. doi: 10.1186/s13012-016-0459-6.
BACKGROUND
Despite substantial evidence for physical activity (PA) as a management option for type 2 diabetes, there remains a lack of PA behavioural interventions suitable for delivery in primary care. This paper describes the systematic development of an evidence-informed PA behavioural intervention for use during routine primary care consultations.
METHODS
In accordance with the Medical Research Council Framework for the Development and Evaluation of Complex Interventions, a four-stage systematic development process was undertaken: (1) exploratory work involving interviews and workshop discussions identified training needs of healthcare professionals and support needs of adults with type 2 diabetes; (2) a systematic review with meta- and moderator analyses identified behaviour change techniques and optimal intervention intensity and duration; (3) usability testing identified strategies to increase implementation of the intervention in primary care and (4) an open pilot study in two primary care practices facilitated intervention optimisation.
RESULTS
Healthcare professional training needs included knowledge about type, intensity and duration of PA sufficient to improve glycaemic control and acquisition of skills to promote PA behaviour change. Patients lacked knowledge about type 2 diabetes and skills to enable them to make sustainable changes to their level of PA. An accredited online training programme for healthcare professionals and a professional-delivered behavioural intervention for adults with type 2 diabetes were subsequently developed. This multifaceted intervention was informed by the theory of planned behaviour and social cognitive theory and consisted of 15 behaviour change techniques. Intervention intensity and duration were informed by a systematic review. Usability testing resolved technical problems with the online training intervention that facilitated use on practice IT systems. An open pilot study of the intervention with fidelity of delivery assessment informed optimisation and identified mechanisms to enhance implementation of the intervention during routine diabetes consultations.
CONCLUSIONS
Movement as Medicine for Type 2 diabetes represents an evidence-informed multifaceted behavioural intervention targeting PA for management of type 2 diabetes developed for delivery in primary care. The structured development process undertaken enhances transparency of intervention content, replicability and scalability. Movement as Medicine for Type 2 diabetes is currently undergoing evaluation in a pilot RCT.
TRIAL REGISTRATION
ISRCTN67997502.
背景
尽管有大量证据表明体育活动（PA）是2型糖尿病的一种管理选择，但仍缺乏适合在初级保健中实施的PA行为干预措施。本文描述了一种基于证据的PA行为干预措施的系统开发过程，该措施用于常规初级保健咨询期间。
方法
根据医学研究理事会关于复杂干预措施开发和评估的框架，进行了四个阶段系统开发过程：（1）探索性工作，包括访谈和研讨会讨论，确定了医疗保健专业人员的培训需求以及2型糖尿病成年人的支持需求；（2）通过荟萃分析和调节分析进行的系统评价，确定了行为改变技术以及最佳干预强度和持续时间；（3）可用性测试确定了提高该干预措施在初级保健中实施的策略，（4）在两个初级保健机构进行的开放性试点研究促进了干预措施的优化。
结果
医疗保健专业人员的培训需求包括了解足以改善血糖控制的PA类型、强度和持续时间的知识，以及获得促进PA行为改变的技能。患者缺乏有关2型糖尿病的知识以及使其能够对PA水平做出可持续改变的技能。随后为医疗保健专业人员开发了一个经认可的在线培训计划，并为2型糖尿病成年人开发了由专业人员提供的行为干预措施。这种多方面的干预措施以计划行为理论和社会认知理论为依据，包括15种行为改变技术。干预强度和持续时间由系统评价确定。可用性测试解决了在线培训干预措施的技术问题，便于在实践信息技术系统上使用。对该干预措施进行的开放性试点研究及实施保真度评估为优化提供了依据，并确定了在常规糖尿病咨询期间加强干预措施实施的机制。
结论
2型糖尿病的运动疗法是一种基于证据的多方面行为干预措施，旨在针对2型糖尿病管理中的PA，专为在初级保健中实施而开发。所进行的结构化开发过程提高了干预内容的透明度、可重复性和可扩展性。2型糖尿病的运动疗法目前正在一项试点随机对照试验中进行评估。
试验注册
ISRCTN67997502
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