Interprofessional follow-up for people at risk of type 2 diabetes in primary healthcare - a randomized controlled trial with embedded qualitative interviews

• Published in: Scandinavian journal of primary health care Vol. 42; no. 3; pp. 450 - 462
• Main Authors: Graue, Marit, Igland, Jannicke, Oftedal, Bjørg Frøysland, Haugstvedt, Anne, Riise, Hilde Kristin Refvik, Zoffmann, Vibeke, Jenum, Anne Karen, Richards, David, Kolltveit, Beate-Christin Hope
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis LLC 01-09-2024; Taylor & Francis; Taylor & Francis Group
• Subjects: Adult; Aged; Body Mass Index; Clinical trials; Diabetes; Diabetes Mellitus, Type 2 - prevention & control; Empowerment; Exercise; Female; Follow-Up Studies; Health care; Health Knowledge, Attitudes, Practice; Humans; Interdisciplinary aspects; Intervention; Interviews; Interviews as Topic; Life Style; Lifestyles; Male; Medical research; Mental health; Middle Aged; Norway; Ownership; Patient Participation; Physical activity; Primary care; Primary Health Care; primary healthcare; Psychological well being; qualitative; Qualitative Research; Quality of Life; randomized controlled trial; Research methodology; self-management; Self-Management - methods; Selfmanagement; Type 2 diabetes; Type 2 diabetes mellitus; Norway; Type 2 diabetes; primary healthcare; qualitative; self-management; randomized controlled trial
• ISSN: 0281-3432; 1502-7724; 1502-7724
• DOI: 10.1080/02813432.2024.2337071

To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants' perceptions of participating in the intervention.
In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019-2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data.
There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: 'Meaningful perspectives on lifestyle changes' and 'Lifestyle change is not a linear process due to challenges faced along the way' putting ownership of their choices in life into picture.
The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.