Reidy Claire, Foster Claire, Rogers Anne
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom.
School of Primary Care, Population Health & Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
J Med Internet Res. 2020 May 1;22(5):e13980. doi: 10.2196/13980.
Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions.
The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM.
Focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention.
A total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information-the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences-taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs-HCPs acknowledge the patient's need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues.
The use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs' apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.
1型糖尿病（T1D）需要强化自我管理（SM）。胰岛素泵旨在更好地支持个人T1D管理，但与此同时，它加剧了自我管理的复杂性和要求。研究表明，糖尿病患者可能会通过基于网络的干预措施受益，这些干预措施提供灵活、创新且易于获得的自我管理方式，帮助他们找到并连接到当地的社会支持和资源。然而，关于这些资源中的哪些行为改变机制对患者最有益，以及如何促进对自我管理干预措施的参与和认可，仍然存在问题。
本研究的目的是评估使用胰岛素泵的T1D患者和专科医疗保健专业人员（HCPs）的观点和经验，并确定需要哪些行为改变特征和策略，以优化现有的基于网络的社交网络（SN）干预措施来支持自我管理。
在英格兰南部6个国民健康服务（NHS）信托机构中，对胰岛素泵使用者（n = 19）和专科HCPs（n = 20）进行焦点小组讨论，研究纳入和自我管理胰岛素泵的障碍和促进因素。使用行为改变轮和理论领域框架进行分析，随后采用行为改变技术分类法（BCTs）来确定复杂健康干预措施的内容和实施策略。
共有4个主题代表了利益相关者的自我管理观点和经验：（1）希望获得量身定制且合适的资源和信息——成功进行自我管理所需的支持和信息是具体情况而定的，并且会根据时间和生活环境而有所不同，因此，这些需要量身定制且合适；（2）特定的社会支持偏好——消除孤立感，同时提供共同的经验教训和实用技巧，但局限性包括担心他人的评判和同伴的自怜；（3）环境背景，即胰岛素泵诊所HCPs的能力和知识——HCPs承认患者需要全面支持，但在提供支持方面缺乏信心；（4）专业责任以及相关的风险和危险，而HCPs担心推广非NHS自我管理支持的后果，并且质疑自我管理支持是否属于他们的职责范围。确定了行为改变技术来解决这些问题。
使用行为理论和经过验证的实施框架为系统识别使用胰岛素泵自我管理T1D的障碍和促进因素提供了一种全面的方法。基于网络的SN干预措施似乎在补充NHS服务的同时，提供了额外形式的自我管理支持。然而，对于干预措施的实施，需要解决HCPs在指向非NHS自我管理支持时对责任的担忧，并且需要添加机会性特征，通过这些特征，胰岛素泵使用者可以积极与其他T1D患者互动。
