Searle Aidan, Wheeler Jessica R, Litchfield Ian, Shield Julian P H, Barrett Timothy, Greenfield Sheila, Leeson-Beevers Kerry, Redwood Sabi
NIHR Biomedical Research Centre - Diet and Physical Activity Theme, University of Bristol, Bristol, UK
Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
BMJ Open. 2025 May 6;15(5):e089372. doi: 10.1136/bmjopen-2024-089372.
To codevelop (with children and young people with diabetes (CYPD)) an intervention to improve diabetes control and future health outcomes of CYPD from 'underserved' groups, to reduce treatment outcome inequalities between different socioeconomic and ethnic groups. To follow Medical Research Council guidance for complex interventions and the COM-B (Capability, Opportunity, Motivation, Behaviour) model for behaviour change intervention development.
In phase 1 (previously reported), we established the evidence base, conducted literature reviews and analysed data from semistructured interviews with CYPD and their carers. In phase 2 (this report), we applied the COM-B framework to identify intervention components; in phase 3 (this report), we evaluated these components, including focus groups with CYPD, their carers' and healthcare practitioner (HCP) surveys, using the Acceptability, Practicability, Effectiveness, Affordability, Spill-Over Effects, Equity criteria.
Secondary care; children, young people and their carers' were approached from two large paediatric diabetes services in England, both with socioeconomically and ethnically diverse underserved populations; paediatric diabetes HCPs were surveyed across four English regions.
N=69 underserved CYPD (aged 5-19 years) and/or family members took part in interviews; N=48 paediatric diabetes HCP survey respondents (survey 1); N=34 paediatric diabetes HCP survey respondents (survey 2); N=3 young people's advisory group participants; N=17 underserved CYPD/carers focus group participants; N=9 wider stakeholder participants.
The codevelopment process and integration of COM-B established four elements for an intervention package: (1) an enhanced peer support/mentoring programme; (2) provision of a health and well-being coach to CYPD/families; (3) family/community support to address social and community issues and (4) training for HCPs, including cultural competence, poverty proofing and to emphasise the need for increased sensitivity and better supported communication in work with CYPD from underserved groups.
The Diversity in Diabetes codevelopment work informed an intervention to improve diabetes care in underserved groups, reflecting sociocultural contexts and plausible support options at the individual, community and clinical levels. The 'Diversity in Diabetes' programme will next test feasibility and further refine the intervention package in two more paediatric diabetes centres in England.
与患有糖尿病的儿童和青少年（CYPD）共同开发一种干预措施，以改善“服务不足”群体中CYPD的糖尿病控制情况和未来健康状况，减少不同社会经济和种族群体之间的治疗结果不平等。遵循医学研究理事会关于复杂干预措施的指南以及行为改变干预措施开发的COM-B（能力、机会、动机、行为）模型。
在第1阶段（先前已报告），我们建立了证据基础，进行了文献综述，并分析了来自与CYPD及其护理人员的半结构化访谈的数据。在第2阶段（本报告），我们应用COM-B框架来确定干预措施的组成部分；在第3阶段（本报告），我们使用可接受性、实用性、有效性、可负担性、溢出效应、公平性标准对这些组成部分进行了评估，包括与CYPD进行焦点小组讨论、对其护理人员和医疗保健从业者（HCP）进行调查。
二级医疗保健；从英格兰的两个大型儿科糖尿病服务机构中招募儿童、青少年及其护理人员，这两个机构的服务对象在社会经济和种族方面都属于服务不足群体；对英格兰四个地区的儿科糖尿病HCP进行了调查。
69名服务不足的CYPD（年龄在5至19岁之间）和/或家庭成员参与了访谈；48名儿科糖尿病HCP参与了调查1；34名儿科糖尿病HCP参与了调查2；3名年轻人咨询小组参与者；17名服务不足的CYPD/护理人员焦点小组参与者；9名更广泛的利益相关者参与者。
共同开发过程和COM-B的整合为一个干预措施包确定了四个要素：（1）一个强化的同伴支持/指导计划；（2）为CYPD/家庭提供一名健康与幸福教练；（3）家庭/社区支持以解决社会和社区问题；（4）对HCP进行培训，包括文化能力、消除贫困以及强调在与服务不足群体的CYPD合作时提高敏感性和提供更好支持性沟通的必要性。
糖尿病多样性共同开发工作为改善服务不足群体的糖尿病护理提供了一种干预措施，反映了社会文化背景以及在个人、社区和临床层面上合理的支持选项。“糖尿病多样性”计划接下来将在英格兰的另外两个儿科糖尿病中心测试可行性并进一步完善干预措施包。
