Table 3 Mapping initial intervention components to the COM-B model and findings from Hynes et al. [19]
COM-B model component | Findings from Hynes et al. | Associated D1 Now intervention component | How the D1 Now intervention component functions? | |
|---|---|---|---|---|
Capability | Psychological Young adults are developing cognitive and interpersonal skills for self-management | - Applicable knowledge is the foundation - Capacity to self-regulate and organise | Florence Agenda setting tool Key worker | Florence: - Florence can send daily blood glucose reminders and provide feedback on the same. - Florence can also send alcohol safety reminders and reminders to check sick day rules Agenda setting tool: - This tool provides a space for the young adult to think about the agenda for their consultation and asks “What would you like to discuss today”. - Allows time to think about possible problems and write them down - avoiding the potential difficulty of verbally expressing problems. Key worker: - Will meet the young adult and explore the capacity to self-regulate and reasons for the same through 1:1 discussion. - Will assist the young adult in articulating problems through introduction of the agenda setting tool and in 1:1 discussions. - Will conduct a needs/priority assessment and identify any needs for referral (e.g. structured education) |
Opportunity | Social Communication and relationships are pivotal in supporting the self-management of young adults with T1D Physical Design of diabetes clinic can be a significant environmental barrier to young adult self-management | - Self-management expectations are generated from diagnosis - Social influences on adjusting to type 1 diabetes and the role of developmental stages - Engage young adults through personalised education and support - Positive feedback from service providers - Challenge to articulate problems and needs to service providers - Impact of connecting with peers with type 1 diabetes | Key Worker Florence | Key worker: - Young adult will build relationship with key worker having moved from paediatric to young adult care. The key worker will conduct needs priority assessments and appropriate referrals. - Can provide link to peer support sessions. Agenda setting tool: - This tool provides a space for the young adult to think about the agenda for their consultation and asks “What would you like to discuss today”. - Allows time to think about possible problems and write them down - avoiding the potential difficulty of verbally expressing problems - Provides a section for the young adult and service provider to set goals together Florence: - Can send “motivational messages” which link to diabetes support websites and blog posts |
- Challenge of delivering young adult-centred services | Agenda Setting Tool Key Worker | Agenda setting tool: - The agenda setting tool aims to build the relationship between the young adult and the healthcare professional during the consultation by allowing the young adult to set own agenda. More holistic discussion also. - The tool has been designed with a cohort of young adults to ensure its young adult centred. - The tool provides a structure to the consultation and ensures the young adults needs are prioritised during the time limited appointment Key worker: - The key worker will provide continuity in the clinic and follow-up on any disengagement from the service. They will also aid the young adult in using the agenda setting tool, so the consultations are young adult focused. | ||
Motivation | Reflective Reconciling identity and self-management Automatic Internal and external factors, including emotions and habits influence self-management | - Resentment versus awareness of self-management benefits - Motivation to demonstrate self-reliance - Reaching a new normal | Florence | Florence: - Can send “motivational messages” which have self-affirming messages and links to diabetes blogs and websites Agenda setting tool - Provides a section for the young adult and service provider to set goals together Key worker - Can work with the young adults to set and track goals and support self-reliance |
- Worry about self-management, diabetes complications and service interactions - Routine supports self-management habits | Florence: - Creating a routine and habit through daily blood glucose reminders. Also by providing feedback and re-enforcement. Agenda setting tool: - The tool explore diabetes distress using the Diabetes Distress Scale (2) and Diabetes Distress Scale (17). Key worker - The key worker will provide continuity in the clinic and reduce stress around clinic engagement. | |||