Huber Claudia, Montreuil Chantal, Christie Derek, Forbes Angus
HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland.
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, London, United Kingdom.
Front Clin Diabetes Healthc. 2022 Jun 3;3:845547. doi: 10.3389/fcdhc.2022.845547. eCollection 2022.
The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management.
Seven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop.
A conceptual framework is proposed in which integration is influenced by five interacting components: the of the diabetes self-management education and support intervention (content and delivery), (the framework in which such interventions are delivered), (the aspects of the people receiving and delivering the interventions), (the interactions between the deliverer and receiver of the intervention), and (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support.
Integration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training.
This synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.
将自我管理教育与支持纳入常规糖尿病护理对于预防并发症至关重要。然而，目前对于如何在自我管理教育与支持方面概念化整合尚无共识。因此，本综述提出了一个将整合与自我管理概念化的框架。
检索了七个电子数据库（Medline、HMIC、PsycINFO、CINAHL、ERIC、Scopus和Web of Science）。21篇文章符合纳入标准。运用批判性解释性综述原则对数据进行综合分析以构建概念框架。在一个多语言研讨会上，将该框架展示给49名在不同护理级别工作的糖尿病专科护士。
提出了一个概念框架，其中整合受到五个相互作用的要素影响：糖尿病自我管理教育与支持干预的 （内容与实施方式）、 （实施此类干预的框架）、 （接受和实施干预的人员的方面）、 （干预实施者与接受者之间的互动）以及 （实施者和接受者从互动中获得的东西）。研讨会参与者的关键意见涉及根据他们的社会语言和教育经历对这些要素赋予的不同优先级。总体而言，他们认同这些要素的概念化及其在糖尿病自我管理教育与支持方面的具体内容。
整合是从干预的关系、伦理、学习、情境适应和系统组织等方面进行概念化的。目前尚不确定要素的哪些优先互动以及这些互动在多大程度上可能调节自我管理教育与支持纳入常规护理的程度；反过来，在每个要素中观察到的整合水平可能调节这些干预的影响，这也可能适用于专业培训的影响。
本综述提供了一个理论框架，该框架在常规护理中的糖尿病自我管理教育与支持背景下对整合进行了概念化。需要更多研究来评估如何在临床实践中处理框架中确定的要素，以评估在这一人群中是否能够有效实现自我管理教育与支持的改善。
