Title: Multilevel Model of Integrated Self-Management Education in People with Type 2 Diabetes: a Qualitative Study
Background: National and international guidelines recognise self-management education as key element of diabetes care. However, less than half of people living with type 2 diabetes participate in self-management education programmes. Developing self-management programmes that are better integrated with patients’ experiences, needs and ongoing care may help improve their uptake.
Aims: To explore the ways different components of integration are expressed at an individual, professional and organisational level within a novel programme of self-management support.
Methods: We conducted a qualitative study using thematic narrative analysis to explore factors influencing integration within the self-management programme. Sixteen purposively sampled programme participants were recruited in two programme settings to participate in semi-structured in-depth interviews. The sample included 10 people with type 2 diabetes, 3 healthcare professionals and 3 lay educators. Ten of the participants were also directly observed during a total of 24 hours of course interactions and 4 related programme documents were analysed. The data were collected in the context of a comparative case study exploring 3 different self-management education programmes aimed at enhancing patient-centred self-management. The ethical permission was provided by the respective authorities.
Results: Five main themes were identified relating to components of integration in self-management education. The themes were: 1) raising the awareness of mutual expectations and roles in the group exchanges by understanding the mechanisms that encourage equal contributions, mainly motivation and position; 2) building a sustainable learning environment by integrating locally available resources that consider the structural and procedural programme aspects to support a continuous active learning; 3) sharing personal experiences by combining learning methods and group support that connects the individual behaviour with common self-management practice; 4) exploring individual challenges for self-management behaviour by responding to the participants’ needs that respect different life priorities and the socio-cultural context; and 5) understanding interactions at the individual, professional and organisational level by encouraging active participation and collaboration as a consequence that reflects a person-centred programme delivery. These components of integration are interrelated and expressed the different interactions occurring in self-management education.
Discussion: Understanding the integration of programme components at the individual, professional and organisational level enables to explore the programme implementation and furthers the development of self-management education. The study highlights the potential impact of interpersonal interaction that encourages the active engagement of people with chronic condition in their self-management. These five components build the basis for the development of the multileveled model to better understand integration in self-management education.

Multilevel model of integrated self-management education in people with type 2 diabetes: a qualitative study