Systematic development of a theory-informed multifaceted behavioural intervention to increase physical activity of adults with type 2 diabetes in routine primary care: Movement as Medicine for Type 2 Diabetes.
Systematic development of a theory-informed multifaceted behavioural intervention to increase physical activity of adults with type 2 diabetes in routine primary care: Movement as Medicine for Type 2 Diabetes.
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DOI：
10.1186/s13012-016-0459-6
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发表时间：
2016-07-19
期刊：
影响因子：
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通讯作者：
Trenell MI
中科院分区：
文献类型：
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作者：
Avery L;Charman SJ;Taylor L;Flynn D;Mosely K;Speight J;Lievesley M;Taylor R;Sniehotta FF;Trenell MI
尽管有大量证据表明体力活动（PA）是2型糖尿病的一种管理选择，但仍然缺乏适合在初级保健中提供的PA行为干预措施。本文介绍了系统的发展，循证PA的行为干预，用于在日常初级保健咨询。根据医学研究理事会复杂干预措施开发和评估框架，进行了四阶段系统开发过程：（1）包括访谈和研讨会讨论的探索性工作，确定了医疗保健专业人员的培训需求和2型糖尿病成人患者的支持需求;（2）通过Meta分析和调节分析进行的系统评价，确定了行为改变技术和最佳干预强度和持续时间;（3）可用性测试确定了增加初级保健干预措施实施的策略，（4）在两个初级保健实践中进行的开放式试点研究促进了干预措施的优化。医疗保健专业人员的培训需求包括关于PA类型、强度和持续时间的知识，这些知识足以改善血液控制和获得促进PA行为改变的技能。患者缺乏有关2型糖尿病的知识和技能，使他们能够对PA水平进行可持续的改变。随后，为医疗保健专业人员开发了一个经过认证的在线培训计划，并为2型糖尿病成人患者开发了一个专业提供的行为干预措施。这一多方面的干预以计划行为理论和社会认知理论为依据，包括15种行为改变技术。干预强度和持续时间通过系统综述进行了说明。可用性测试解决了在线培训干预的技术问题，促进了在实践IT系统上的使用。一项关于干预措施的开放性试点研究，评估了交付保真度，并确定了在常规糖尿病咨询期间加强干预措施实施的优化机制。运动作为2型糖尿病的药物代表了一种循证多方面的行为干预，针对PA用于管理2型糖尿病，为初级保健提供服务。所进行的结构化开发流程增强了干预内容的透明度、可复制性和可扩展性。运动作为2型糖尿病的药物目前正在进行一项试点RCT的评估。 ISRCTN 67997502本文的在线版本（doi：10.1186/s13012-016-0459-6）包含补充材料，可供授权用户使用。
Despite substantial evidence for physical activity (PA) as a management option for type 2 diabetes, there remains a lack of PA behavioural interventions suitable for delivery in primary care. This paper describes the systematic development of an evidence-informed PA behavioural intervention for use during routine primary care consultations. In accordance with the Medical Research Council Framework for the Development and Evaluation of Complex Interventions, a four-stage systematic development process was undertaken: (1) exploratory work involving interviews and workshop discussions identified training needs of healthcare professionals and support needs of adults with type 2 diabetes; (2) a systematic review with meta- and moderator analyses identified behaviour change techniques and optimal intervention intensity and duration; (3) usability testing identified strategies to increase implementation of the intervention in primary care and (4) an open pilot study in two primary care practices facilitated intervention optimisation. Healthcare professional training needs included knowledge about type, intensity and duration of PA sufficient to improve glycaemic control and acquisition of skills to promote PA behaviour change. Patients lacked knowledge about type 2 diabetes and skills to enable them to make sustainable changes to their level of PA. An accredited online training programme for healthcare professionals and a professional-delivered behavioural intervention for adults with type 2 diabetes were subsequently developed. This multifaceted intervention was informed by the theory of planned behaviour and social cognitive theory and consisted of 15 behaviour change techniques. Intervention intensity and duration were informed by a systematic review. Usability testing resolved technical problems with the online training intervention that facilitated use on practice IT systems. An open pilot study of the intervention with fidelity of delivery assessment informed optimisation and identified mechanisms to enhance implementation of the intervention during routine diabetes consultations. Movement as Medicine for Type 2 diabetes represents an evidence-informed multifaceted behavioural intervention targeting PA for management of type 2 diabetes developed for delivery in primary care. The structured development process undertaken enhances transparency of intervention content, replicability and scalability. Movement as Medicine for Type 2 diabetes is currently undergoing evaluation in a pilot RCT. ISRCTN67997502 The online version of this article (doi:10.1186/s13012-016-0459-6) contains supplementary material, which is available to authorized users.