Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
BMJ Open. 2022 May 27;12(5):e059853. doi: 10.1136/bmjopen-2021-059853.
To examine context-specific delivery factors, facilitators and barriers to implementation of the Diabetes Community Exercise and Education Programme (DCEP) for adults with type 2 diabetes (T2D) using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.
A qualitative evaluation embedded within the DCEP pragmatic randomised controlled trial. Data collected via focus groups and interviews and analysed thematically.
Community-based in two cities (Dunedin and Invercargill) in the lower south island of New Zealand.
Seventeen adults diagnosed with T2D attending DCEP and 14 healthcare professionals involved in DCEP delivery.
DCEP is a twice weekly session of exercise and education over 12 weeks, followed by a twice weekly ongoing exercise class.
While our reach target was met (sample size, ethnic representation), the randomisation process potentially deterred Māori and Pasifika from participating. The reach of DCEP may be extended through the use of several strategies: promotion of self-referral, primary healthcare organisation ownership and community champions. DCEP was considered effective based on perceived benefit. The social and welcoming environment created relationships and connections. People felt comfortable attending DCEP and empowered to learn. Key to implementation and adoption was the building of trusting relationships with local health providers and communities. This takes time and care and cannot be rushed. Training of staff and optimising communication needed further attention. To maintain DCEP, delivery close to where people live and a generic approach catering for people with multiple chronic conditions may be required.
For success, lifestyle programmes such as DCEP, need time and diligence to build and maintain networks and trust. Beyond frontline delivery staff and target populations, relationships should extend to local healthcare organisations and communities. Access and ongoing attendance are enabled by healthcare professionals practicing in a nuanced person-centred manner; this, plus high staff turnover, necessitates ongoing training.
ACTRN12617001624370.
使用实施、有效性、采用、推广及维持框架，从具体实施背景出发，调查影响成人 2 型糖尿病患者（T2D）参与糖尿病社区锻炼与教育项目（DCEP）的实施因素、促进因素和障碍因素。
DCEP 实用随机对照试验中的定性评估。通过焦点小组和访谈收集数据，并进行主题分析。
新西兰南岛低地两个城市（达尼丁和因弗卡吉尔）的社区。
17 名被诊断患有 T2D 并参加 DCEP 的成年人和 14 名参与 DCEP 实施的医疗保健专业人员。
DCEP 为每周两次的锻炼和教育课程，共 12 周，之后是每周两次的持续锻炼课程。
尽管我们达到了目标（样本量、种族代表性），但随机化过程可能会阻止毛利人和太平洋岛民参与。可以通过多种策略来扩大 DCEP 的覆盖面：推广自我推荐、基层医疗组织拥有权和社区拥护者。根据感知到的益处，DCEP 被认为是有效的。友好和欢迎的环境建立了关系和联系。人们觉得参加 DCEP 很舒服，并有权学习。建立与当地卫生提供者和社区的信任关系是实施和采用的关键。这需要时间和关心，不能急于求成。需要进一步关注员工培训和优化沟通。为了维持 DCEP，需要在人们居住的地方提供服务，并采取通用方法满足患有多种慢性病的人群的需求。
对于成功，DCEP 等生活方式项目需要时间和努力来建立和维护网络和信任。除了一线服务人员和目标人群外，关系还应延伸到当地医疗保健组织和社区。医疗保健专业人员以细致入微的方式进行实践，使获得医疗服务和持续参与成为可能；加上员工高流动率，需要持续培训。
ACTRN12617001624370。
