背景:尽管已经发现行为干预有助于控制2型糖尿病(T2D),重要的是要了解交付环境如何影响实施和结果。NHS致力于测试低热量饮食(LCD)计划,旨在支持超重和T2D生活的人减肥并改善糖尿病结局。了解在计划试点期间影响实施的因素对于优化推广非常重要。这项研究探索了NHSLCD计划在更广泛采用之前的可转移性。
方法:与参与试点实施LCD计划的利益相关者进行了25次访谈(卫生服务负责人,转介卫生专业人员和计划交付者)。在一个更大的工作方案内对方案参与者(患有T2D的人)进行了访谈,探索什么有效,为谁和为什么,这是单独报告的。概念性人口-干预-环境-转移模型(PIET-T)指导研究设计和数据收集。在数据分析期间,模型的构造也被用作演绎编码帧。确定了关键主题,为优化计划转移提供了建议。
结果:人口:某些地区的转诊策略缺乏对人口特征的考虑。许多人认为,提供交付模式的选择将促进合格人口的可接受性和可及性。
方法:总的来说,由于强大的证据基础和轶事证据,利益相关者对LCD计划充满信心,但一些人认为复杂的转诊过程阻碍了GP实践的参与。
方法:利益相关者描述了访问该计划的障碍,包括语言和学习困难。可转让性:多学科工作和有效沟通支持成功实施。
结论:在计划转移过程中,应考虑向代表性不足的群体提供转诊策略,以及服务提供商提供的有关访问和计划收益的及时数据。递送模型的选择可以优化摄取。鼓励各网站之间分享关于良好工作做法的知识,包括增加与关键利益相关者的接触。
BACKGROUND: Although behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low-calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the
transferability of the NHS LCD Programme prior to wider adoption.
METHODS: Twenty-five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population-Intervention-Environment-Transfer Model of
Transferability (PIET-T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer.
RESULTS: Population: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population.
METHODS: Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices.
METHODS: Stakeholders described barriers to accessing the programme, including language and learning difficulties.
Transferability: Multidisciplinary working and effective communication supported successful implementation.
CONCLUSIONS: Referral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders.