Campbell Fiona, Lawton Julia, Rankin David, Clowes Mark, Coates Elizabeth, Heller Simon, de Zoysa Nicole, Elliott Jackie, Breckenridge Jenna P
School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England.
The Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland.
BMC Health Serv Res. 2018 Nov 27;18(1):898. doi: 10.1186/s12913-018-3655-z.
People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia. However, many struggle to sustain these improvements over time. To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants' self-management behaviours after attending structured education and their need for support to sustain improvements in glycaemic control.
We undertook a meta-ethnography of relevant qualitative studies, identified using systematic search methods. Studies were included which focused on participants' experiences of self-managing type 1 diabetes after attending structured education which incorporated training in flexible intensive insulin therapy. A line of argument approach was used to synthesise the findings.
The search identified 18 papers from six studies. The studies included were judged to be of high methodological quality. The line of argument synthesis developed the Follow-Up Support for Effective type 1 Diabetes self-management (FUSED) model. This model outlines the challenges participants encounter in maintaining diabetes self-management practices after attending structured education, and describes how participants try to address these barriers by adapting, simplifying or personalising the self-management approaches they have learned. To help participants maintain the skills taught during courses, the FUSED model presents ten recommendations abstracted from the included papers to provide a logic model for a programme of individualised and responsive follow-up support.
This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour. To help people sustain diabetes self-management skills after attending structured education, it is recommended that support be provided over the longer-term by appropriately trained healthcare professionals which is responsive to individuals' needs. Although developed to inform support for people with type 1 diabetes, the FUSED model provides a framework that could also be applied to support individuals with other long term conditions which require complex self-management skills to be learned and sustained over time.
PROSPERO registration: CRD42017067961 .
接受使用灵活强化疗法的结构化自我管理教育培训的1型糖尿病患者血糖控制得到改善，严重低血糖发作次数减少。然而，许多人难以长期维持这些改善。为了为设计更有效的后续支持提供依据，我们对定性研究进行了综述，这些研究确定了影响和告知参与者在参加结构化教育后自我管理行为的因素，以及他们维持血糖控制改善所需的支持。
我们对相关定性研究进行了元民族志研究，通过系统搜索方法确定研究。纳入的研究聚焦于参与者在参加包含灵活强化胰岛素治疗培训的结构化教育后自我管理1型糖尿病的经历。采用论证方法对研究结果进行综合。
搜索确定了六项研究中的18篇论文。纳入的研究被判定具有较高的方法学质量。论证综合得出了1型糖尿病有效自我管理后续支持（FUSED）模型。该模型概述了参与者在参加结构化教育后维持糖尿病自我管理实践中遇到的挑战，并描述了参与者如何通过调整、简化或个性化所学的自我管理方法来应对这些障碍。为帮助参与者维持课程中教授的技能，FUSED模型从纳入的论文中提炼出十条建议，为个性化和响应式后续支持计划提供逻辑模型。
这项元民族志研究突出表明，向1型糖尿病患者提供结构化教育的技能培训不一定会使参与者采用并维持推荐的行为改变。为帮助人们在参加结构化教育后维持糖尿病自我管理技能，建议由经过适当培训的医疗保健专业人员提供长期支持，并根据个人需求做出响应。尽管FUSED模型是为指导对1型糖尿病患者的支持而开发的，但它提供了一个框架，也可应用于支持患有其他需要长期学习和维持复杂自我管理技能的慢性病患者。
PROSPERO注册：CRD42017067961 。
