TY  - JOUR
AU  - Carswell, Claire
AU  - Coventry, Peter A
AU  - Brown, Jennifer V E
AU  - Alderson, Sarah L
AU  - Double, Keith
AU  - Gilbody, Simon
AU  - Holt, Richard I G
AU  - Jacobs, Rowena
AU  - Lister, Jennie
AU  - Osborn, David
AU  - Shiers, David
AU  - Siddiqi, Najma
AU  - Taylor, Johanna
AU  - Kellar, Ian
PY  - 2023
DA  - 2023/5/12
TI  - Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach
JO  - J Med Internet Res
SP  - e43597
VL  - 25
KW  - severe mental illness
KW  - diabetes
KW  - intervention development
KW  - co-design
KW  - mental health
KW  - comorbidity
KW  - mobile phone
AB  - Background: Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. Objective: We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. Methods: The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. Results: Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. Conclusions: The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial. 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e43597
UR  - https://doi.org/10.2196/43597
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37171868
DO  - 10.2196/43597
ID  - info:doi/10.2196/43597
ER  -