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      The Diabetes and Emotional Health Handbook and Toolkit for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes: Formative Evaluation

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          Abstract

          Background

          Health professionals have expressed unmet needs, including lacking the skills, confidence, training, and resources needed to properly attend to the psychological needs of people with diabetes.

          Objective

          Informed by needs assessments, this study aimed to develop practical, evidence-based resources to support health professionals to address the emotional needs of adults with type 1 or type 2 diabetes.

          Methods

          We developed a new handbook and toolkit informed by formative evaluation, including literature reviews, stakeholder consultation and review, and a qualitative study. In the qualitative study, health professionals participated in interviews after reading sections of the handbook and toolkit.

          Results

          The literature review uncovered that psychological problems are common among adults with diabetes, but health professionals lack resources to provide related support. We planned and drafted resources to fill this unmet need, guided by stakeholder consultation and an Expert Reference Group (ERG). Before finalizing the resources, we implemented feedback received from stakeholders (ERG, health professionals, academics, and people with diabetes). The resulting resources were the practical, evidence-based Diabetes and Emotional Health handbook and toolkit. A total of 19 health professionals took part in the qualitative study about the handbook and toolkit. They viewed the resources favorably, felt empowered to support people with diabetes experiencing psychological problems, and felt motivated to share the resources with others. Some gave examples of how they had used the handbook in clinical practice. A perceived highlight was the inclusion of a process model outlining 7 steps for identifying and supporting people with emotional problems: the 7 A’s model. With funding from the National Diabetes Services Scheme (NDSS), more than 2400 copies of Diabetes and Emotional Health have been distributed. It is freely available on the Web. The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia.

          Conclusions

          The new evidence-based resources are perceived by stakeholders as effective aids to assist health professionals in providing emotional support to adults with diabetes. The 7 A’s model may have clinical utility for routine monitoring of other psychological and health-related problems, as part of person-centered clinical care.

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          Most cited references19

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          4. Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care, and Immunization

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            Assessing delivery of the five 'As' for patient-centered counseling.

            The '5As' model of behavior change provides a sequence of evidence-based clinician and office practice behaviors (Assess, Advise, Agree, Assist, Arrange) that can be applied in primary care settings to address a broad range of behaviors and health conditions. Although the 5As approach is becoming more widely adopted as a strategy for health behavior change counseling, practical and standardized assessments of 5As delivery are not widely available. This article provides clinicians and researchers with alternatives for assessment of 5As implementation for both quality improvement, and for research and evaluation purposes, and presents several practical tools they may wish to use. Sample instruments for tracking delivery of the 5As and related tools that are in the public domain are provided to facilitate integration of self-management support into clinical care. We discuss the strengths and limitations of the various assessment approaches. Promising and practical measures to assess the 5As exist for both quality improvement and research purposes. Additional validation is needed on almost all current procedures, and both clinicians and researchers are encouraged to use these instruments and share the resulting data.
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              Monitoring of Individual Needs in Diabetes (MIND): Baseline Data From the Cross-National Diabetes Attitudes, Wishes, and Needs (DAWN) MIND Study

              OBJECTIVE To test the feasibility and impact of implementing the computer-assisted Monitoring of Individual Needs in Diabetes (MIND) procedure, which is aimed at improving recognition and management of the psychological needs of diabetic patients in routine care. RESEARCH DESIGN AND METHODS The MIND study was implemented in diabetes clinics across eight countries as part of the annual review. The computerized assessment covered emotional well-being (World Health Organization 5 Well-Being Index), diabetes-related distress (Problem Areas in Diabetes), life events, and the patient’s agenda. Medical data were retrieved from the charts, and agreed-upon actions were recorded. RESULTS Of 1,567 patients monitored using the MIND, 24.9% had either likely depression or high diabetes-related distress; 5.4% had both. Over 80% of these patients were newly identified cases, and 41% of patients with depression were referred to a mental health professional. CONCLUSIONS Monitoring of well-being and diabetes-related distress as part of routine diabetes care is feasible and helps to identify and discuss unmet psychosocial needs.
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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                February 2020
                21 February 2020
                : 4
                : 2
                : e15007
                Affiliations
                [1 ] School of Psychology Deakin University Geelong Australia
                [2 ] The Australian Centre for Behavioural Research in Diabetes Diabetes Victoria Melbourne Australia
                [3 ] Applied Health Psychology Research Hornchurch, Essex United Kingdom
                [4 ] Sydney Medical School The University of Sydney Sydney Australia
                [5 ] Diabetes & Medical Psychology Services Normanhurst Australia
                Author notes
                Corresponding Author: Jennifer A Halliday j.halliday@ 123456deakin.edu.au
                Author information
                https://orcid.org/0000-0003-1156-279X
                https://orcid.org/0000-0002-1204-6896
                https://orcid.org/0000-0002-1535-3496
                https://orcid.org/0000-0003-2468-1253
                https://orcid.org/0000-0002-0075-828X
                Article
                v4i2e15007
                10.2196/15007
                7060499
                32130112
                a36022d2-d459-41ea-bfc5-7d0e6ad76f0a
                ©Jennifer A Halliday, Jane Speight, Andrea Bennet, Linda J Beeney, Christel Hendrieckx. Originally published in JMIR Formative Research (http://formative.jmir.org), 21.02.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included.

                History
                : 13 June 2019
                : 24 September 2019
                : 8 October 2019
                : 22 October 2019
                Categories
                Original Paper
                Original Paper

                diabetes mellitus,mental health,medical reference books,needs assessment,evaluation studies,qualitative research

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