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

糖尿病是许多低收入和中等收入国家决策者面临的首要健康挑战。自我管理规划为改善中低收入国家的糖尿病自我管理提供了一种可能具有成本效益的干预措施。然而，关于自我管理方案在低收入和中等收入国家背景下如何有效的证据有限。行为改变技术（bct）是高收入国家广泛使用的工具，用于制定和描述针对健康行为的行为改变干预措施，通常用于糖尿病自我管理规划。然而，关于在中低收入国家使用bct的证据仍然不足，因此尚不清楚这些工具在这些情况下的适用程度。中低收入国家与高收入国家相比，患者的价值观、经历和信仰可能存在各种差异，而高收入国家主要对bct进行了测试和分类。目前尚不清楚这些因素是否或如何影响低收入和中等收入国家背景下bct的功能，以及这些因素如何影响这些背景下干预措施的有效性。需要确定现有自我管理方案中使用的btc与低收入和中等收入国家情况的相关性，以便最大限度地提高有效性。因此，本项目将利用中低收入国家糖尿病自我管理项目正在进行的过程评估中的二手数据，研究环境如何影响bct在糖尿病自我管理项目中的有效性和可接受性；GUIDES试验（乌干达和泰国的妊娠糖尿病）和DSME-T试验（泰国的2型糖尿病）。该项目的目的是：a)确定哪些bct已用于中低收入国家的糖尿病自我管理项目，以及这些技术在中低收入国家的效果如何。b)在干预实施、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项目有效性的决定因素。c)调查环境如何影响bct在中低收入国家糖尿病自我管理项目中的适用性和可接受性。d)编制并验证一份问卷，以衡量参与者对bct干预措施的态度。我将对中低收入国家的糖尿病自我管理计划和使用的bct文献进行系统综述。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估。这将考虑基于MRC进程评估框架的因素：背景、实施和机制（包括BCTs）。这些数据将在试验地点进行三角测量。在此之后，我将综合和比较指南和DSME-T试验中使用bct的定性数据，以确定上下文之间的异同。最后，我将制作一份关于参与者对bct态度的问卷。我将使用泰国合作者收集的这份问卷的信度和效度数据，使用因子分析等统计方法对这份问卷进行验证。本项目将涉及混合方法分析，包括对大数据集的定量分析和问卷的验证。这将培养我与MRC优先级一致的定量技能。为了支持这一点，我在第一学期参加了LSHTM理学硕士模块“流行病学和人口健康统计”，并将在我的混合方法研究项目中寻求培训。b)该项目涉及与跨学科团队合作，包括试验国家的保健专业人员和政策制定者，以交流相关发现。这与MRC对跨学科技能的优先考虑是一致的。c)该项目也符合MRC全球卫生和实施研究的研究主题，因为它寻求支持干预措施的有效实施

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