为患有2型糖尿病和学习障碍的成年人开发一种支持性自我管理干预措施。

Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability.

作者信息

House Allan, Latchford Gary, Russell Amy M, Bryant Louise, Wright Judy, Graham Elizabeth, Stansfield Alison, Ajjan Ramzi

机构信息

1Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK.

2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK.

出版信息

Pilot Feasibility Stud. 2018 May 29;4:106. doi: 10.1186/s40814-018-0291-7. eCollection 2018.

DOI:10.1186/s40814-018-0291-7

PMID:29862037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5975532/

Abstract

BACKGROUND

Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population.

METHODS

In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention.

RESULTS

The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation.

CONCLUSIONS

The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41897033 (registered 21/01/2013).

摘要

背景

尽管支持性自我管理是慢性病管理中公认的一部分，但它尚未被常规用作有学习障碍成年人医疗保健的一部分。我们基于支持性自我管理原则，并针对目标人群进行合理调整，为患有轻度或中度学习障碍及2型糖尿病的成年人开发了一种干预措施。

方法

我们分五步进行：阐明已发表文献中报道的支持性自我管理原则；确定有学习障碍的成年人在2型糖尿病有效自我管理方面的障碍；审查旨在支持有学习障碍者糖尿病自我管理的现有材料；综合前三阶段的成果，确定支持性自我管理中与我们目标人群需求最相关且最有可能被他们接受和有用的要素；实施并实地测试该干预措施。

结果

最终干预措施有四个标准化组成部分：（1）确立参与者的日常活动和生活方式；（2）确定支持者及其角色；（3）利用这些信息设定现实目标，并向患者和支持者提供材料以帮助实现目标；（4）对照目标监测进展。在一项可行性随机对照试验中随机分组的41人中，35人（85%）完成了干预课程，超过四分之三的所有参与者（78%）参加了至少三节课。40名参与者中有23人（58%）被认为非常积极参与课程，12/40（30%）积极参与材料学习；30名（73%）参与者在至少一节课中有另一人陪同；据报告15/41（37%）有一位积极参与的主要支持者，18/41（44%）有另一个不是其主要支持者但参与干预实施的人。