Patient Activation Intervention For Diabetes Care In Primary Care Setting

Abstract

Diabetes mellitus is a debilitating chronic condition and the number of affected people is increasing worldwide. Evidence has acknowledged that optimum diabetes control lies upon the pharmacological treatment and patients’ capacity to self-manage. Currently, there has been a focus on the concept of ‘patient activation’, emphasising patients’ active role and the need for them to have the knowledge, confidence, as well as skills to self-manage. Findings from existing patient activation studies had not found conclusive evidence on which intervention works best. This study aimed to develop a new patient activation intervention, known as “Act and Control Your Diabetes” for patients with diabetes in a primary care setting. This study was divided into three phases, guided by the action research framework. The initial step was to explore the activation process from patients’ perspectives, of which findings helped in designing a novel intervention. Ten in-depth interviews were conducted and the data were analysed with a thematic analysis approach. Five overarching themes, seventeen themes and ten subthemes were generated. The first overarching theme was ‘Initial reactions towards diabetes’ described the early impression of diabetes encompassing a negative emotion, a lack of concern and low efficacy towards treatment. ‘Process of discovery’ was the second overarching theme, marking the journey in finding the exact truth and learning the consequences of ignoring the responsibility. The third overarching theme, ‘Making the right decision,’ pictured that fear triggered a decision-making process and paved the way in making a turning point, moving towards activation. ‘Starting to accept the responsibility’ was the fourth overarching theme, highlighted that in the earlier process of activation, patients learned about their role, took one step at a time and sought help for certain challenging tasks. The fifth overarching theme, ‘Keeping oneself on the track’, portrayed that patients needed to have problem-solving skills and develop self-resilient in maintaining activation. This

qualitative study concluded that the basic elements needed are comprehensive self- management education and facilitation into daily lives. However, there was no

structured diabetes education available in the primary care clinic. Therefore, these components had become the main focus of the new intervention. During the second phase of the study, the new intervention was developed in collaboration with various healthcare providers. The new intervention was tested through a pilot randomised controlled trial among patients with uncontrolled diabetes (n=22), using a newly validated Malay version of the Patient Activation Measure questionnaire. The results showed that after six months, the patient activation score did not differ between the intervention and control groups. The activation score was increased for both groups, but it was larger in the intervention (difference =16.56, 95% CI: 3.15, 29.97) compared to the control group (difference= 7.88, 95% CI:1.22,14.54). Among the secondary outcomes, only the problem-focused coping score was significantly different between groups (p=0.003). A significant improvement in illness perception, overall confidence score and fasting blood sugar was observed in the intervention group. The intervention group also had higher satisfaction and perceived the intervention as beneficial. Despite the limited significant findings, the new intervention has the potential to enhance patient activation and could be applied to the current clinical practice.