Nield Lucie, Bhanbhro Sadiq, Steers Helen, Young Anna, Fowler Davis Sally
Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S10 2BP, UK.
Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK.
Healthcare (Basel). 2023 Sep 8;11(18):2499. doi: 10.3390/healthcare11182499.
The Voluntary, Community and Social Enterprise (VCSE) sector offers services and leadership within the health and care system in England and has a specialist role in working with underserved, deprived communities. This evaluation aims to identify best practices in self-management support for those living with type 2 diabetes mellitus (T2DM) and to develop a theory of change (TofC) through understanding the impact of VCSE organisations on diabetes management. An appreciative inquiry (AI) was carried out and co-delivered using qualitative interviews and an embedded analysis with VCSE partners. A voluntary service coordinated seven VCSE organisations who assisted with recruiting their service users and undertook interviews to identify the impact of existing activities and programmes. People living with T2DM were interviewed about services. Themes were as follows: (a) individual and group activities; (b) trusted services and relationships across the community; (c) long-term engagement; (d) sociocultural context of diet and nutritional choices; (e) experience of adaptation; and (f) culturally appropriate advice and independent VCSE organisations. The structured educational approach (DESMOND) for T2DM was accessed variably, despite these services being recommended by NICE guidelines as a standard intervention. The VCSE offered continuity and culturally appropriate services to more marginalised groups. This evaluation highlights the importance of targeted engagement with underserved communities, particularly where primary care services are more limited. The TofC is a unique insight into the impact of VCSE services, offering bespoke support to manage T2DM, suggesting areas for improvements in capacity and offering the capability to sustain the VCSE sector as an essential element of the T2DM care pathway in England.
志愿、社区及社会企业（VCSE）部门在英格兰的医疗保健系统中提供服务并发挥引领作用，在与服务不足、贫困社区合作方面发挥着专业作用。本评估旨在确定针对2型糖尿病（T2DM）患者自我管理支持的最佳实践，并通过了解VCSE组织对糖尿病管理的影响来构建变革理论（TofC）。开展了一项赏识性探询（AI），并与VCSE合作伙伴共同采用定性访谈和嵌入式分析的方式进行。一项志愿服务协调了七个VCSE组织，这些组织协助招募其服务用户，并进行访谈以确定现有活动和项目的影响。对T2DM患者进行了关于服务的访谈。主题如下：（a）个人和团体活动；（b）社区内可信赖的服务和关系；（c）长期参与；（d）饮食和营养选择的社会文化背景；（e）适应体验；（f）文化上合适的建议和独立的VCSE组织。尽管这些服务被英国国家卫生与临床优化研究所（NICE）指南推荐为标准干预措施，但针对T2DM的结构化教育方法（DESMOND）的使用情况各不相同。VCSE为更边缘化的群体提供了连续性和文化上合适的服务。本评估强调了与服务不足社区进行有针对性接触的重要性，特别是在初级保健服务更为有限的地方。变革理论是对VCSE服务影响的独特见解，为管理T2DM提供定制支持，提出能力提升的改进领域，并提供维持VCSE部门作为英格兰T2DM护理途径重要组成部分的能力。
