Developing and evaluating a diabetes self-management intervention for people with severe mental illness: The DIAMONDS programme (Diabetes and Mental Illness, Improving Outcomes and Self-management)
People with severe mental illness die 15-20 years younger than the general population, and diabetes is a major driver of that gap. Existing diabetes self-management programmes work well for most people, but they ignore the cognitive, motivational, and social barriers that make it harder for someone with a mental illness to manage their blood sugar, diet, and medication. This programme will design and test a tailored diabetes self-management intervention—called DIAMONDS—specifically for people with severe mental illness and type 2 diabetes. If it works, the intervention could close a widening health inequality: without it, standard programmes risk leaving this group further behind. The researchers will also build a framework to adapt the approach for other long-term conditions, such as chronic obstructive pulmonary disease, so the same principle could apply across physical health problems that disproportionately affect people with mental illness. The project is applied and practical—it aims to produce a tested, cost-effective intervention ready for NHS rollout.
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Aims: We will develop and evaluate a diabetes self-management intervention for people with severe mental illness and type 2 diabetes, and explore the generalisability of our approach to other comorbid long-term physical health conditions. Objectives: Identify factors that promote or inhibit self-management behaviours in people with severe mental illness and comorbid long-term conditions. Design self-management interventions for diabetes and for chronic obstructive pulmonary disease (COPD) that address these factors, and refine their design through iterative testing. Optimise the design of the diabetes self-management intervention and trial design. Determine clinical and cost-effectiveness of the diabetes self-management intervention. Estimate its longer-term cost-effectiveness. Develop a framework for adapting self-management interventions for other long-term conditions in severe mental illness. Background: People with severe mental illness experience higher rates of physical illness and a shorter life expectancy by 15-20 years. Diabetes contributes significantly to this health inequality, being 2-3 times more common and having poorer outcomes in severe mental illness compared with the general population. Self-management is the cornerstone of good diabetes care. Diabetes self-management programmes are effective in improving clinical outcomes and reducing healthcare costs, and are recommended for all individuals with diabetes in the UK. However, existing programmes do not address the additional cognitive, motivational, lifestyle and socio-economic challenges faced by people with mental illness. As self-management programmes are rolled out in the UK, tailored programmes for people with co-existing mental illness are required to avoid a widening of already prevalent health inequalities. Research plan: Following the Medical Research Council framework for design and evaluation of complex interventions, and drawing on our NIHR Programme Development Grant work, this programme comprises six complementary work-streams: Work-stream 1: A narrative synthesis of the literature and a qualitative study involving individual interviews with patients (n=35), and focus groups with carers (n=18) and with healthcare staff (n=18) will help identify potentially modifiable factors that promote or inhibit self-management in people with severe mental illness alongside any long-term physical condition. Work-stream 2: Informed by findings from work-stream 1 and our previous work, expert consensus will be used to select intervention targets and behaviour change techniques that can modify these determinants, to include in tailored diabetes and COPD self-management interventions. We will co-design both of these interventions with patients, carers and healthcare staff (n=15), and develop digital applications, as deemed appropriate, to support them. We will iteratively test intervention components with patients (n=15-20) to optimise their potential acceptability and efficacy. Work-stream 3: We will assess acceptability and feasibility of delivering the diabetes self-management intervention (which we are calling DIAMONDS), and of evaluating it in a trial. Thirty-two participants with severe mental illness and type 2 diabetes will be recruited from two mental health trusts and 10 general practices and randomised (1.2:1 ratio) to receive the DIAMONDS intervention or usual care in a feasibility trial. We will collect data for our planned outcome measures and monitor intervention adherence. Thematic analysis of semi-structured interviews with patients (n=19), carers (n=9) and healthcare staff (n=10) will identify ways to optimise the intervention and trial design, and inform development of a training package for staff delivering the intervention. Work-stream 4: In a multi-centre randomised controlled trial (including an internal pilot) of 446 participants from 10 mental health trusts and 60 general practices randomised (1.2:1 ratio), we will test effectiv
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