Developing and feasibility testing a novel intervention to promote self-management for Jordanian patients presenting with an Acute Coronary Syndrome and Type 2 diabetes

Abstract

Background: A quarter of the world’s patients with acute coronary syndrome (ACS) reportedly have type 2 diabetes (T2D). Although self-management education and support are cornerstones in the treatment of long-term conditions, interventions to promote integrated self-management behaviours in those with T2D and ACS have not been explored nor implemented in practice. This limits such patients' quality of life significantly.
Aim: To develop and feasibility test a novel, integrated self-management intervention for Jordanian patients with T2D and ACS, after an acute coronary event.
Methods: Mixed methods sequential embedded design incorporating two phases:
• Phase One: Data from a systematic review of the literature, 17 interviews with
patients and 6 focus group interviews with professionals were synthesised and used to inform the development of the novel Diabetes Cardiac Self-Management (DCSM) Intervention.
• Phase Two: Combining aspects of the Common-Sense Model of Self-Regulation, with the information sources for improving patient’s self-efficacy and the teach-back educational method produced a "triple-pillared" theory-based intervention strategy and guide accurate measurement of outcomes. The application of the intervention was assessed in a non-randomised feasibility study. The intervention consisted of three inhospital education sessions and one follow-up supportive phone call.
Results: Phase one data confirmed that the existing evidence on support for patients with both conditions was inadequate. Present practice did not include self-management education and support for such patients following diagnosis with ACS in Jordan. Consequently, patients’ knowledge, confidence and adherence were poor. The challenges patients face in living with both conditions and their education- and support-related preferences were identified. In Phase two, 20 patients were successfully recruited over 9 weeks, with high recruitment and retention rates. The study procedures and intervention were feasible to deliver and highly acceptable to participants. Preliminary evaluation of the intervention shows promise.
Conclusions: In a healthcare setting in which those with two serious, long-term
conditions receive no routine education or support to enable them to manage their conditions, this study has provided a foundation upon which effective interventions can be developed in future.

Date of Award	Nov 2018
Original language	English
Supervisor	Vivien Coates (Supervisor) & Paul Slater (Supervisor)