Bozkurt Deniz, Duaso Maria, Sturt Jackie
Division of Care in Long-Term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK.
Division of Care in Long-Term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK.
Lancet. 2023 Nov;402 Suppl 1:S27. doi: 10.1016/S0140-6736(23)02135-9.
The Women's Wellness with Type 2 Diabetes Programme (WWDP) is an online behavioural intervention for midlife women living with type 2 diabetes. The gender-specific intervention fosters self-efficacy, encouraging positive wellbeing behaviours to enhance diabetes and menopause outcomes. In 2016, We co-led a feasibility trial and process evaluation with 70 women aged 45-50 years from the UK and Australia. The intervention comprised an e-book, a website, and nurse consultations. The WWDP seemed to improved diabetes distress, self-efficacy, and menopausal symptoms, but with impactful, costly, diabetes nurse input, compromising feasibility and delivery by the NHS. We report WWDP refinement using the 2021 Medical Research Council (MRC) framework for complex interventions to optimise future implementation.
Intervention refinement was guided by six core MRC elements of context, programme theory, stakeholder engagement, key uncertainties, intervention refinement, and economic considerations. Critical analysis of quantitative and qualitative feasibility data, informed by self-efficacy theory, provided a deeper understanding of how the intervention was used. Eight PPI consultations took place between Sept 1, 2021, and Dec 31, 2022, with three women from diverse cultural and socioeconomic backgrounds and three female diabetes professionals to strengthen the e-book and methods of support for women undertaking the programme.
Context was improved by the feasibility study and the PPI consultations, making the e-book relevant to UK health care. Understanding that self-efficacy was supported through primary use of peer group, and goal setting components supported the existing programme theory. Stakeholder engagement shaped the structure of the online peer support group. The feasibility study revealed uncertainties around goal settings. These uncertainties were addressed by introducing individualised goals focusing on aspects like medication adherence. The nurse support in the intervention was replaced with peer support, which might lead to greater economic feasibility of the programme. An optimised website and individualised goal setting underpin the WWDP.
The MRC Framework provides intervention refinement structure, allowing adaptive adjustments based on emerging evidence, feedback, and contextual nuances. Limitations exist. Intervention refinements, including peer support, might affect adherence and unexpected interactions. New components could influence long-term efficacy.
Turkish Ministry of National Education.
2型糖尿病女性健康计划（WWDP）是一项针对患有2型糖尿病的中年女性的在线行为干预措施。这种针对性别的干预措施可增强自我效能感，鼓励积极的健康行为，以改善糖尿病和更年期相关的结果。2016年，我们与来自英国和澳大利亚的70名45至50岁的女性共同开展了一项可行性试验和过程评估。干预措施包括一本电子书、一个网站以及护士咨询服务。WWDP似乎改善了糖尿病困扰、自我效能感和更年期症状，但由于需要投入大量精力且成本高昂的糖尿病护士参与，影响了其可行性以及英国国家医疗服务体系（NHS）的推广。我们报告了利用2021年医学研究理事会（MRC）复杂干预框架对WWDP进行优化，以促进其未来的实施。
干预措施的优化以MRC的六个核心要素为指导，即背景、项目理论、利益相关者参与、关键不确定性、干预措施优化和经济考量。基于自我效能理论对定量和定性可行性数据进行批判性分析，能更深入地了解干预措施的使用方式。在2021年9月1日至2022年12月31日期间进行了八次患者和公众参与（PPI）咨询，与三名来自不同文化和社会经济背景的女性以及三名女性糖尿病专业人员共同加强了电子书内容以及为参与该计划的女性提供支持的方法。
可行性研究和PPI咨询改善了背景情况，使电子书与英国医疗保健相关。认识到自我效能感主要通过同龄人群体的互动得到支持，目标设定部分也支持了现有的项目理论。利益相关者的参与塑造了在线同龄人群体支持小组的结构。可行性研究揭示了目标设定方面存在的不确定性。通过引入关注药物依从性等方面的个性化目标解决了这些不确定性。干预措施中的护士支持被同龄人群体支持所取代，这可能会提高该计划在经济上的可行性。一个经过优化的网站和个性化目标设定是WWDP的基础。
MRC框架为干预措施优化提供了结构，允许根据新出现的证据、反馈和背景细微差别进行适应性调整。存在局限性。包括同龄人群体支持在内的干预措施优化可能会影响依从性和产生意外的互动。新的组成部分可能会影响长期疗效。
土耳其国家教育部。
