Type 2 diabetes is a chronic condition primarily self-managed by the individual. Mastery is a protective factor linked to better control of chronic conditions, effective self-management and improved medication adherence. Mastery appears increasingly important as treatment regimens and self-management demands become more complex and burdensome. Diabetes distress negatively impacts self-management, glycaemic control and treatment adherence. Understanding the relationship between diabetes distress and mastery may provide opportunities to improve condition management and adherence . This relationship may be impacted by other factors affecting the individual's perceived sense of control over their condition. This study examined the role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. Data were drawn from a randomised controlled trial of 131 adults with type 2 diabetes transitioning to injection therapy. Participants completed measures of diabetes distress , mastery , depression and empowerment . Diabetes distress and depression were negatively associated with mastery, whilst diabetes empowerment was positively associated . A significant interaction effect (b = .024, t(112) = 3.79, p = <.005) confirmed the relationship between diabetes distress and mastery was moderated by depression. Findings highlight the additive deleterious effects of depression. Interventions to improve mastery among those living with type 2 diabetes should address diabetes distress and depression to optimise outcomes.

It is estimated among individuals with type 2 diabetes (T2D) requiring injectable therapies to achieve optimal glycaemic control, one-third are reluctant to initiate therapies, with approximately 80% choosing to discontinue or interrupt injectable regimens soon after commencement. Initiation of injectables is a complex issue, with effectiveness of such treatments undermined by non-adherence or poor engagement. Poor engagement and adherence are attributed to psychological aspects such as individuals' negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control over their condition. The aim of this study was to describe the development of a structured diabetes intervention to address psychological barriers to injectable treatments among a cohort of those with T2D; conducted within a behavioural change framework. An evidence base was developed to inform on key psychological barriers to injectable therapies. A systematic review highlighted the need for theory-based, structured diabetes education focussed on associated psychological constructs to inform effective, patient-centric provisions to improve injectable initiation and persistence. Findings from the focus groups with individuals who had recently commenced injectable therapies, identified patient-centric barriers to initiation and persistence with injectables. Findings from the systematic review and focus groups were translated via Behavioural Change Wheel (BCW) framework to develop an intervention for people with T2D transitioning to injectable therapies: Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This article describes how psychological barriers informed the intervention with these mapped onto relevant components, intervention functions and selected behaviour change techniques, and finally aligned with behaviour change techniques. This article outlines the systematic approach to intervention development within the BCW framework; guiding readers through the practical application of each stage. The use of the BCW framework has ensured the development of the intervention is theory driven, with the research able to be evaluated and validated through replication due to the clarity around processes and tasks completed at each stage.

Diabetes education aims to equip people with diabetes with positive self-care behaviours and management strategies to improve glycaemic control. The preferred outcome measure of education effectiveness is often HbA(1c) reduction. However, the move towards person-centred education has led to renewed calls to capture associated behavioural and psychosocial change. The aim of this study was to review indicators of diabetes education efficacy in light of the growing emphasis on person-centric care. A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases, from January 2006 to December 2016, was conducted. Studies meeting the inclusion criteria, focusing on diabetes education effectiveness primarily measured using HbA(1c), were selected. Twenty-three studies were included, comprising 6747 participants. They yielded mixed results, with 13 studies reporting significant reductions in HbA(1c) following intervention. Thirteen studies assessed multiple behavioural and psychosocial measures as secondary outcomes with significant, positive changes in these outcomes following intervention. Studies utilising diabetes-specific measures yielded positive results. It was concluded successful diabetes education involves changing participant cognitions and behaviours. Changes in behavioural and psychosocial aspects should inform education effectiveness. Development of effective diabetes education programmes requires better understanding of how they affect behavioural and psychosocial change, facilitating glycaemic control. Copyright (C) 2019 John Wiley & Sons.

This paper outlines a small study undertaken to assess user perspectives on the concept of social prescription services. Social prescribing is a mechanism linking patients in primary care with non-medical sources of support within the community. The work presented here supports the idea of patients becoming ‘active partners’ by providing health literature that is designed to suit their health literacy along with a service which introduces patients to actual programmes and services in their local area which suit their specific condition. By using innovative digital technology patient engagement is encouraged leading to greater self-care and independence in relation to long-term condition management.

The aim of this position paper is to examine the case for supporting behaviour change in pre-diabetic obese people in order to improve their health. The paper sets out the background and motivation for supporting behaviour change before outlining the relevant literature in this health and wellbeing area. The paper then explores the feasibility of SmartLife — a patient-driven application involving healthcare practitioners and peer support interaction with a focus on failure-free, positive reinforcement, patient empowerment and wellbeing.