Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: Qualitative study

Aujla, Navneet; Yates, Thomas; Dallosso, Helen; Kai, Joe

Abstract

Objectives: To explore service-user and provider experience of the acceptability and feasibility of the Let’s Prevent Diabetes programme, a pragmatic six-hour behavioural intervention using structured group education, introduced into primary care practice.

Design: Qualitative interview-based study.

Setting: Primary care and community.

Participants: Purposeful sample of 32 participants, including 22 people at high risk of diabetes who either attended, defaulted from, or declined the intervention; and 10 stakeholder professionals involved in implementation.

Results: Participants had low prior awareness of their elevated risk and were often surprised to be offered intervention. Attenders were commonly older, white, retired and motivated to promote their health; who found their session helpful, particularly for social interaction, raising dietary awareness, and convenience of community location. Attenders highlighted lack of depth, repetition within and length of session, difficulty meeting culturally diverse needs, and no follow up as negative features. Those who defaulted from, or who declined the intervention were apprehensive, uncertain or unconvinced about whether they were at risk; sought more specific information about the intervention, and were deterred by its group nature and day-long duration, with competing work or family commitments. Local providers recognised inadequate communication of diabetes risk to patients. They highlighted challenges for implementation, including resource constraints, and facilitation at individual general practice or locality level.

Conclusions: This pragmatic diabetes prevention intervention was acceptable and feasible in practice, particularly for older, white, retired and health-motivated people. Pre-intervention information and communication of diabetes risk should be improved, with closer integration of services, to facilitate uptake and follow up. Further development of this, or other interventions, is needed to enable wider, and more socially diverse, engagement of people at risk. Balancing a locality and individual practice approach, and how this is resourced are considerations for longer-term sustainability.

Citation

Aujla, N., Yates, T., Dallosso, H., & Kai, J. (2019). Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: Qualitative study. BMJ Open, 9(8), Article e028491. https://doi.org/10.1136/bmjopen-2018-028491

• Journal Article Type: Article
• Acceptance Date: Jul 4, 2019
• Online Publication Date: Aug 2, 2019
• Publication Date: Aug 2, 2019
• Deposit Date: Jul 11, 2019
• Publicly Available Date: Jul 12, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 8
• Article Number: e028491
• DOI: https://doi.org/10.1136/bmjopen-2018-028491
• Keywords: Behavioural intervention; Diabetes prevention; Primary care; Qualitative Study
• Public URL: https://nottingham-repository.worktribe.com/output/2299402
• Publisher URL: https://bmjopen.bmj.com/content/9/8/e028491
• Contract Date: Jul 11, 2019