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Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study

BACKGROUND: In a previous study, participation in a 16-week reverse integrated care and group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (hemoglobin A(1c)) and BMI. To inform future implementation eff...

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Autores principales: Schnitzer, Kristina, Cather, Corrine, Zvonar, Vanya, Dechert, Alyson, Plummer, Rachel, Lowman, Kelsey, Pachas, Gladys, Potter, Kevin, Evins, Anne Eden
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910121/
https://www.ncbi.nlm.nih.gov/pubmed/33576747
http://dx.doi.org/10.2196/21934
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author Schnitzer, Kristina
Cather, Corrine
Zvonar, Vanya
Dechert, Alyson
Plummer, Rachel
Lowman, Kelsey
Pachas, Gladys
Potter, Kevin
Evins, Anne Eden
author_facet Schnitzer, Kristina
Cather, Corrine
Zvonar, Vanya
Dechert, Alyson
Plummer, Rachel
Lowman, Kelsey
Pachas, Gladys
Potter, Kevin
Evins, Anne Eden
author_sort Schnitzer, Kristina
collection PubMed
description BACKGROUND: In a previous study, participation in a 16-week reverse integrated care and group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (hemoglobin A(1c)) and BMI. To inform future implementation efforts, more information about the effective components of the intervention is needed. OBJECTIVE: The goal of this study is to identify the aspects of the intervention participants reported to be helpful and to evaluate the predictors of outcomes. METHODS: This study involved qualitative evaluation and post hoc quantitative analysis of a previous intervention. Qualitative data were collected using semistructured interviews with 69% (24/35) of the individuals who attended 1 or more group sessions and 35% (9/26) of the individuals who consented but attended no sessions. Quantitative mixed effects modeling was performed to test whether improved diabetes knowledge, diet, and exercise or higher group attendance predicted improved hemoglobin A(1c) and BMI. These interview and modeling outcomes were combined using a mixed methods case study framework and integrated thematically. RESULTS: In qualitative interviews, participants identified the application of health-related knowledge gained to real-world situations, accountability for goals, positive reinforcement and group support, and increased confidence in prioritizing health goals as factors contributing to the success of the behavioral intervention. Improved knowledge of diabetes was associated with reduced BMI (β=–1.27, SD 0.40; P=.003). No quantitative variables examined were significantly associated with improved hemoglobin A(1c) levels. CONCLUSIONS: In this mixed methods analysis of predictors of success in a behavioral diabetes management program, group participants highlighted the value of positive reinforcement and group support, accountability for goals set, and real-world application of health-related knowledge gained. Improved diabetes knowledge was associated with weight loss.
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spelling pubmed-79101212021-03-04 Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study Schnitzer, Kristina Cather, Corrine Zvonar, Vanya Dechert, Alyson Plummer, Rachel Lowman, Kelsey Pachas, Gladys Potter, Kevin Evins, Anne Eden J Particip Med Original Paper BACKGROUND: In a previous study, participation in a 16-week reverse integrated care and group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (hemoglobin A(1c)) and BMI. To inform future implementation efforts, more information about the effective components of the intervention is needed. OBJECTIVE: The goal of this study is to identify the aspects of the intervention participants reported to be helpful and to evaluate the predictors of outcomes. METHODS: This study involved qualitative evaluation and post hoc quantitative analysis of a previous intervention. Qualitative data were collected using semistructured interviews with 69% (24/35) of the individuals who attended 1 or more group sessions and 35% (9/26) of the individuals who consented but attended no sessions. Quantitative mixed effects modeling was performed to test whether improved diabetes knowledge, diet, and exercise or higher group attendance predicted improved hemoglobin A(1c) and BMI. These interview and modeling outcomes were combined using a mixed methods case study framework and integrated thematically. RESULTS: In qualitative interviews, participants identified the application of health-related knowledge gained to real-world situations, accountability for goals, positive reinforcement and group support, and increased confidence in prioritizing health goals as factors contributing to the success of the behavioral intervention. Improved knowledge of diabetes was associated with reduced BMI (β=–1.27, SD 0.40; P=.003). No quantitative variables examined were significantly associated with improved hemoglobin A(1c) levels. CONCLUSIONS: In this mixed methods analysis of predictors of success in a behavioral diabetes management program, group participants highlighted the value of positive reinforcement and group support, accountability for goals set, and real-world application of health-related knowledge gained. Improved diabetes knowledge was associated with weight loss. JMIR Publications 2021-02-12 /pmc/articles/PMC7910121/ /pubmed/33576747 http://dx.doi.org/10.2196/21934 Text en ©Kristina Schnitzer, Corrine Cather, Vanya Zvonar, Alyson Dechert, Rachel Plummer, Kelsey Lowman, Gladys Pachas, Kevin Potter, Anne Eden Evins. Originally published in Journal of Participatory Medicine (http://jopm.jmir.org), 12.02.2021. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Journal of Participatory Medicine, is properly cited. The complete bibliographic information, a link to the original publication on http://jopm.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Schnitzer, Kristina
Cather, Corrine
Zvonar, Vanya
Dechert, Alyson
Plummer, Rachel
Lowman, Kelsey
Pachas, Gladys
Potter, Kevin
Evins, Anne Eden
Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title_full Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title_fullStr Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title_full_unstemmed Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title_short Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study
title_sort patient experience and predictors of improvement in a group behavioral and educational intervention for individuals with diabetes and serious mental illness: mixed methods case study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910121/
https://www.ncbi.nlm.nih.gov/pubmed/33576747
http://dx.doi.org/10.2196/21934
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