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Supporting Self-management of diabetes in India


Faculty of Health Sciences and Sport

About the Project

India is home to over 72 million people with diabetes, with diabetes related complications emerging as the leading cause of mortality and morbidity, an under-appreciated cause of poverty and a significant development challenge. Effective self-management education and support can reduce the risk of complications, yet its provision is inadequate and sub-optimal in India. Current efforts rely on traditional ‘information and advice giving’, which is evidenced to be ineffective and inadequate for behaviour change. Evidence, mainly from high income countries, favours alternative approaches based on principles of person-centred care and behaviour which focus on building people’s skills and self-efficacy, addressing support needs and providing personalised care. Such approaches to self-management education and support are urgently required in India to improve diabetes outcomes and reduce premature mortality. This project will use theoretical and co-production approaches to inform a diabetes self-management support intervention that is likely to be effective, feasible and coherent with cultural realities in India.

The project will:
• Identify challenges to effective self-management of diabetes from different stakeholder perspectives (patients, carers, health professionals/workers, policy makers, voluntary sectors)
• Enhance understanding of the social, cultural, economic, and health system related context impacting on self-management and support.
• Identify, using health psychology theories, what kind of intervention is needed, who it could be aimed at, what content and format is required, where should it be delivered, and what may be the likely mechanisms and outcomes of change.
• Explore feasibility and acceptability of a prototype self-management support intervention.
This PhD will use theories from health psychology (related to self-management support, health behaviour change and shared decision-making), adopt coproduction and MRC complex intervention frameworks and involve use of mixed methods including questionnaires, qualitative interviews and/or focus groups as well as innovative approaches combining use of storytelling/photo-voice methods. The project is flexible, allowing the student take initiative and explore and develop their ideas.

References

Leventhal H, et al. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J of Beh Med. 2016;39(6):935-46

IDF Diabetes Atlas International Diabetes Federation. 2017. Available from: http://www.diabetesatlas.org.

Nagpal J, et al. Quality of diabetes care in the middle- and high-income group populace: the Delhi Diabetes Community (DEDICOM) survey. Diab care. 2006;29(11):2341-8.

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) [Internet]. [cited 2018 Oct 8]. Available from: http://www.nrhmhp.gov.in/sites/default/files/files/NCD_Guidelines.pdf

Norris SL, et al. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diab care. 2001;24(3):561-87.

Pati S, et al. Prevalence and pattern of co morbidity among type2 diabetics attending urban primary healthcare centers at Bhubaneswar (India). PLOS ONE. 2017;12(8):e0181661.

Swanson V, et al. Motivational and behaviour change approaches for improving diabetes management. Pract Diab. 2019;36(4):121-5

Tandon N, et al. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016. The Lancet Global Health. 2018;6(12):e1352-e62.


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