PITCH: Exploring the Experience of a 'Diagnosis' of Pre-diabetes and Factors Influencing Uptake of a Lifestyle Intervention Programme in Areas of Socio-economic Deprivation

Problem

People living in socio-economically deprived areas are at higher risk of developing diabetes and have worse health outcomes when they do. A Diabetes Prevention Programme (DPP) is being rolled out across England with eligibility linked to a HbA1c screening test to ‘diagnose’ pre-diabetes (42-47 mmol/mol). The DPP is a lifestyle intervention offering a nine month individualised programme aiming to reduce progression to diabetes, through optimization of diet and physical activity to achieve weight loss. Previous studies suggest that patients from lower socio-economic groups are less likely to engage with and benefit from lifestyle interventions. The DPP may increase health inequalities unless barriers to engagement are considered.

Approach

A literature review has been completed to inform development of a topic guide.

A purposive sample of ‘pre-diabetic’ patients who have been offered referral to the DPP and are registered at practices within the Yorkshire and Humber 'Deep End' Research Cluster will be invited to participate in a semi-structured interview study.

Each interview will be transcribed and analysed by systematically coding the data into categories and subcategories to identify emerging concepts using thematic analysis. Independent verification of themes will be undertaken by two experienced qualitative researchers (HT, CM) to triangulate data interpretation. Initial analyses will allow modification of the questions to take to the next interview in an iterative process. Interviews will continue until the team agree that data saturation is reached. Discussion of the data with the research team will lead to the development of a rigorous thematic framework justified by, and linked to, the interview data.

Findings

PPI work has been carried out with a 'Deep End' PPI group of patients from areas of socio-economic deprivation. Participants agreed that intervening to prevent diabetes in people at higher risk was an important thing to do. There was concern amongst the group that a nine month programme would be too great a commitment and that irregular working patterns could make the programme difficult to attend.

Key themes from the literature review were

-lack of knowledge about pre-diabetes

-ambivalance

-influence of health care professionals

Patient recruitment and interviews will take place throughout spring 2018.

Consequences

This project aims to enrich primary care practitioners’ understanding of patients’ responses to a diagnosis of pre-diabetes. This is a common condition which we are being encouraged to diagnose and manage and it is important that this is done in a manner that will provide maximum benefit to patients and the health service.

Understanding barriers and facilitators to uptake of a lifestyle intervention in patients from areas of socioeconomic deprivation could help practitioners to have more useful conversations with this group of patients. It could potentially lead to tailoring of the DPP to better meet the needs of this group.