Nursing quantitative research article II

A nurse-led interdisciplinary approach to promote self- management of type 2 diabetes: a process evaluation of post- intervention experiences Lisa C. Whitehead PhD,1 Marie T. Crowe PhD,2 Janet D. Carter PhD,3 Virginia R. Maskill MHealSc,4

Dave Carlyle PhD,5 Carol Bugge PhD6 and Chris M. A. Frampton PhD7

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1Professor of Nursing Research, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia 2Professor of Nursing Research, Centre for Postgraduate Nursing Studies, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand 3Associate Professor, Department of Psychology, University of Canterbury, Christchurch, New Zealand 4Lecturer, Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand 5Senior Lecturer, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand 6Senior Lecturer, School of Health Sciences, University of Stirling, Stirling, UK 7Professor, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

Keywords evaluation, experience

Correspondence Lisa Whitehead School of Nursing and Midwifery Edith Cowan University 270 Joondalup Drive, Joondalup Western Australia Australia E-mail: l.whitehead@ecu.edu.au

Accepted for publication: 8 June 2016

doi:10.1111/jep.12594

Abstract Rationale, aims and objectives Self-management of type 2 diabetes through diet, exercise and for many medications, are vital in achieving and maintaining glycaemic control in type 2 diabetes. A number of interventions have been designed to improve self-management, but the outcomes of these are rarely explored from a qualitative angle and even fewer through a process evaluation. Method A process evaluation was conducted using a qualitative design with participants randomized to an intervention. Seventy-three people living with type 2 diabetes and hyperglycaemia for a minimum of 1 year, randomized to one of two interventions (n = 34 to an education intervention and n = 39 to an education and acceptance and commitment therapy intervention) completed stage one of the process evaluation, immediately following the intervention through written feedback guided by open-ended questions. A purposive sample of 27 participants completed semi-structured interviews at 3 and 6 months post inter- vention. Interview data were transcribed and data analysed using a thematic analysis. Results The majority of participants described an increase in knowledge around diabetes self-management and an increased sense of personal responsibility. Participants also de- scribed changes in self-management activities and reflected on the challenges in instigating and maintaining change to improve diabetes management. Conclusion The complexities of implementing change in daily life to improve glycaemic control indicate the need for ongoing support post intervention, which may increase and maintain the effectiveness of the intervention.

Introduction

Glycaemic control is the primary goal in diabetes management and the key factor in the development of long-term complications [1]. Living with diabetes presents many challenges, including daily choices and actions that have a direct impact on blood glucose (e.g. exercise, stress, and for many, medication management) [2]. The short-term and long-term effects of hyperglycaemia are multi- ple, including microvascular (e.g. retinopathy, nephropathy and neuropathy) and macrovascular (e.g. heart disease) changes. Interventions to improve glycaemic control can be broadly catego-

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