Odgers-Jewell Kate, Isenring Elisabeth, Thomas Rae, Reidlinger Dianne P
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia,, Gold Coast, Queensland, Australia.
Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Queensland, Australia.
Nutr Diet. 2017 Jul;74(3):243-252. doi: 10.1111/1747-0080.12327. Epub 2016 Oct 10.
The present study developed and evaluated a patient-centred, patient-directed, group-based education program for the management of type 2 diabetes mellitus.
Two frameworks, the Medical Research Council (MRC) framework for developing and evaluating complex interventions and the RE-AIM framework were followed. Data to develop the intervention were sourced from scoping of the literature and formative evaluation. Program evaluation comprised analysis of primary recruitment of participants through general practitioners, baseline and end-point measures of anthropometry, four validated questionnaires, contemporaneous facilitator notes and telephone interviews with participants.
A total of 16 participants enrolled in the intervention. Post-intervention results were obtained from 13 participants, with an estimated mean change from baseline in weight of -0.72 kg (95%CI -1.44 to -0.01), body mass index of -0.25 kg/m (95%CI -0.49 to -0.01) and waist circumference of -1.04 cm (95%CI -4.52 to 2.44). The group education program was acceptable to participants. The results suggest that recruitment through general practitioners is ineffective, and alternative recruitment strategies are required.
This patient-centred, patient-directed, group-based intervention for the management of type 2 diabetes mellitus was both feasible and acceptable to patients. Health professionals should consider the combined use of the MRC and RE-AIM frameworks in the development of interventions to ensure a rigorous design process and to enable the evaluation of all phases of the intervention, which will facilitate translation to other settings. Further research with a larger sample trialling additional recruitment strategies, evaluating further measures of effectiveness and utilising lengthier follow-up periods is required.
本研究开发并评估了一项以患者为中心、由患者主导的、基于小组的2型糖尿病管理教育项目。
遵循了两个框架，即医学研究理事会（MRC）开发和评估复杂干预措施的框架以及RE-AIM框架。开发该干预措施的数据来源于文献综述和形成性评估。项目评估包括通过全科医生对参与者进行初步招募的分析、人体测量学的基线和终点指标、四份经过验证的问卷、同期主持人记录以及对参与者的电话访谈。
共有16名参与者纳入该干预措施。13名参与者获得了干预后的结果，估计体重较基线的平均变化为-0.72千克（95%置信区间-1.44至-0.01），体重指数为-0.25千克/米²（95%置信区间-0.49至-0.01），腰围为-1.04厘米（95%置信区间-4.52至2.44）。小组教育项目为参与者所接受。结果表明，通过全科医生进行招募效果不佳，需要采用其他招募策略。
这种以患者为中心、由患者主导、基于小组的2型糖尿病管理干预措施对患者而言既可行又可接受。卫生专业人员在开发干预措施时应考虑联合使用MRC和RE-AIM框架，以确保设计过程严谨，并能够对干预措施的各个阶段进行评估，这将有助于将其推广到其他环境。需要进行进一步的研究，采用更大的样本，试验其他招募策略，评估更多的有效性指标，并采用更长的随访期。
