Improving the effectiveness of diabetes self-management programmes in low-and middle-income countries through behaviour change theory

通过行为改变理论提高低收入和中等收入国家糖尿病自我管理计划的有效性

• 批准号: 2734759
• 金额: --
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2734759
• 关键词: Improving; effectiveness; diabetes; self; management

Diabetes is a foremost health challenges facing policy makers in many low-and middle-income countries (LMICs). Self-management programmes offer a potentially cost-effective intervention to improve diabetes self-management in LMICs. However, there is limited evidence on how effective self-management programmes are in LMIC contexts. Behaviour change techniques (BCTs) are widely used tools to develop and describe behaviour change interventions for health behaviour in high-income countries (HICs) and are commonly employed in diabetes self-management programmes. However, there remains a deft of evidence on the use of BCTs in LMICs, making it unclear how applicable these tools are in these contexts. A variety of differences may exist in patient's values, experiences and beliefs in LMICs compared to HICs where BCTs have primarily been tested and categorised. It is unclear whether or how these factors may impact the functioning of BCTs in the LMIC context, or how this may impact on the effectiveness of interventions in these settings. The relevance of BCTs used in existing self-management programmes to LMIC contexts needs to be determined in order to maximise effectiveness. Therefore, this project will examine how context influences the effectiveness and acceptability of BCTs in diabetes self-management programmes by utilising secondary data from ongoing process evaluations of diabetes self-management programmes in LMICs; the GUIDES trial (gestational diabetes in Uganda and Thailand), and the DSME-T (type 2 diabetes in Thailand). The aims of this project will be to:a) Identify which BCTs have been used in diabetes self-management programmes in LMICs, and how effective these techniques have been in the LMIC contexts.b) Establish the determinants of effectiveness of diabetes self-management programmes in India and Uganda in terms of intervention implementation, context and behaviour change mechanisms.c) Investigate how context influences the applicability and acceptability of BCTs in diabetes self-management programmes in LMICs.d) Develop and validate a questionnaire to measure participants attitudes to BCTs in interventions. I will conduct a systematic review of the literature on diabetes self-management programmes in LMICs and the BCTs used. This will help to guide the rest of the project. I will then use qualitative and quantitative data collected by the GUIDES research teams in India and Uganda to conduct a mixed-methods process evaluation of the GUIDES trial. This will consider factors based on the MRC framework for process evaluations: context, implementation and mechanisms (including BCTs). This data will be triangulated across the trial sites. Following this, I will synthesise and compare qualitative data on the use of BCTs in the GUIDES and DSME-T trials to identify similarities and differences between the contexts. Finally, I will develop a questionnaire on participant's attitudes towards BCTs. Using data on reliability and validity of this questionnaire which will be collected by collaborators in Thailand, I will use statistical methods such as factor analysis to validate this questionnaire. Skills gaineda) This project will involve mixed-methods analysis, including quantitative analysis of large data sets and validation of a questionnaire. This will develop my quantitative skills in line with the MRC priority. To support this, I have taken the LSHTM MSc module "Statistics for Epidemiology and Population Health" in my first term and will seek training during my project on mixed-methods research.b) This project involves working with interdisciplinary teams, including healthcare professionals and policy makers in trial countries to communicate relevant findings. This is in line with the MRC priority of interdisciplinary skills. c) This project is also in line with the MRC research themes of global health and implementation research as it seeks to support the effective implementation of intervention

糖尿病是许多低收入和中等收入国家（LMICs）决策者面临的首要健康挑战。自我管理计划提供了一种潜在的具有成本效益的干预措施，以改善中低收入国家的糖尿病自我管理。然而，关于自我管理方案在低收入国家中的有效性的证据有限。行为改变技术（BCT）是广泛使用的工具，用于制定和描述高收入国家（HIC）健康行为的行为改变干预措施，并通常用于糖尿病自我管理计划。然而，在中低收入国家使用生物技术的证据仍然不多，因此不清楚这些工具在这些情况下的适用性。与BCT主要被测试和分类的HIC相比，LMIC中患者的价值观、经历和信念可能存在各种差异。目前尚不清楚这些因素是否或如何影响在低收入国家背景下BCT的功能，或者这如何影响在这些环境中干预措施的有效性。需要确定现有自我管理方案中使用的最佳现金援助与低收入国家情况的相关性，以便最大限度地提高效力。因此，本项目将研究背景如何影响BCT在糖尿病自我管理项目中的有效性和可接受性，方法是利用LMIC糖尿病自我管理项目正在进行的过程评估的二级数据; GUIDES试验（乌干达和泰国的妊娠糖尿病）和DSME-T（泰国的2型糖尿病）。本项目的目的是：a）确定哪些最佳控制疗法已用于低收入国家的糖尿病自我管理方案，以及这些技术在低收入国家的环境中的有效性; B）在干预措施的实施、环境和行为改变机制方面，确定印度和乌干达糖尿病自我管理方案有效性的决定因素; c）调查环境如何影响最佳控制疗法在低收入国家糖尿病自我管理方案中的适用性和可接受性; d）制定并验证一份问卷，以衡量参与者对最佳控制疗法在干预措施中的态度。我将对有关中低收入国家糖尿病自我管理计划和所使用的BCT的文献进行系统回顾。这将有助于指导项目的其余部分。然后，我将使用印度和乌干达的GUIDES研究小组收集的定性和定量数据，对GUIDES试验进行混合方法过程评价。这将考虑基于MRC流程评估框架的因素：背景、实施和机制（包括BCT）。这些数据将在各试验中心进行三角测量。在此之后，我将综合和比较在GUIDES和DSME-T试验中使用BCT的定性数据，以确定上下文之间的相似性和差异。最后，我将制定一份问卷调查参与者对BCT的态度。利用在泰国的合作者收集的问卷的信度和效度数据，我将使用因素分析等统计方法来验证这份问卷。该项目将涉及混合方法分析，包括对大型数据集的定量分析和对问卷的验证。这将发展我的定量技能与MRC的优先权。为了支持这一点，我在第一个学期参加了LSHTM MSc模块“流行病学和人口健康统计学”，并将在我的混合方法研究项目期间寻求培训。B）该项目涉及与跨学科团队合作，包括试验国家的医疗保健专业人员和政策制定者，以交流相关发现。这符合MRC跨学科技能的优先顺序。c）这个项目也符合医学研究委员会的全球健康和实施研究主题，因为它寻求支持有效实施干预措施