Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen-Copenhagen University Hospital, Herlev, Denmark.
Section of Health Services Research, Department of Public Health, Copenhagen University, Copenhagen, Denmark.
JMIR Form Res. 2024 Oct 18;8:e58658. doi: 10.2196/58658.
Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care.
This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress.
The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach.
The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills.
This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms.
糖尿病困扰是指患者因糖尿病的治疗需求而产生的负面情绪反应；这种情况在超过 40%的 1 型糖尿病（T1D）患者中发生。然而，目前并没有专门设计的干预措施可以将减少糖尿病困扰作为糖尿病护理的一个组成部分。
本研究旨在修改和改编现有的循证方法，形成一种由护士主导的小组干预措施，以降低 T1D 成人患者的糖尿病困扰程度，尤其是那些中重度糖尿病困扰患者。
本研究的整体框架以医学研究委员会（MRC）复杂干预框架的初始阶段为指导，重点是进行干预措施的识别和开发，以指导干预措施的改编。本研究于 2019 年 11 月至 2021 年 6 月在丹麦的 2 个专门的糖尿病中心进行。共有 36 名 T1D 成人参加了 10 个平行工作坊。共有 12 名糖尿病专科护士接受了访谈并参加了 1 次共创工作坊；12 名多学科专家，包括心理学家、教育专家和研究人员，参加了 4 次共创工作坊和 14 次反馈会议。数据分析采用演绎分析方法。
该干预措施包括 5 次每两周进行一次、每次 2.5 小时的小组会议，参与者为 T1D 成人患者和糖尿病困扰患者。该干预措施由 2 名经过培训的糖尿病专科护士按照详细的分步操作手册进行指导。干预措施的材料包括 7 种糖尿病特异性来源的视觉对话工具，这些工具涵盖了 28 项 1 型糖尿病困扰量表中测量糖尿病困扰的 7 个方面：（1）无力感，（2）自我管理，（3）对低血糖的恐惧，（4）饮食，（5）朋友和家人，（6）负面社会认知，以及（7）医生困扰。这些工具旨在引发对糖尿病特定挑战和优势的意识和分享、个人反思，以及关于管理糖尿病困扰策略的全体会议和同伴间讨论，为糖尿病担忧和克服负面情绪的策略提供新视角。糖尿病专科护士表示需要一本手册，其中包含方法描述和使用工具的详细指南。为了实施该干预措施，护士需要增加对糖尿病困扰、如何支持减少糖尿病困扰以及培训和监督以提高技能的了解。
本共同设计研究描述了一种具有强大循证基础的复杂干预措施的改编，包括对理论基础和核心机制的详细报告。
