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Open Access 01-12-2022 | Care | Research article

Using Normalisation Process Theory (NPT) to develop an intervention to improve referral and uptake rates for self-management education for patients with type 2 diabetes in UK primary care

Authors: Jessica Turner, Graham Martin, Nicky Hudson, Liz Shaw, Lisa Huddlestone, Christina Weis, Alison Northern, Sally Schreder, Melanie Davies, Helen Eborall

Published in: BMC Health Services Research | Issue 1/2022

Abstract

Background

Referral and uptake rates of structured self-management education (SSME) for Type 2 diabetes (T2DM) in the UK are variable and relatively low. Research has documented contributing factors at patient, practitioner and organisational levels. We report a project to develop an intervention to improve referral to and uptake of SSME, involving an integrative synthesis of existing datasets and stakeholder consultation and using Normalisation Process Theory (NPT) as a flexible framework to inform the development process.

Methods

A three-phase mixed-methods development process involved: (1) synthesis of existing evidence; (2) stakeholder consultation; and (3) intervention design. The first phase included a secondary analysis of data from existing studies of T2DM SSME programmes and a systematic review of the literature on application of NPT in primary care. Influences on referral and uptake of diabetes SSME were identified, along with insights into implementation processes, using NPT constructs to inform analysis. This gave rise to desirable attributes for an intervention to improve uptake of SSME. The second phase involved engaging with stakeholders to prioritise and then rank these attributes, and develop a list of associated resources needed for delivery. The third phase addressed intervention design. It involved translating the ranked attributes into essential components of a complex intervention, and then further refinement of components and associated resources.

Results

In phase 1, synthesised analysis of 64 transcripts and 23 articles generated a longlist of 46 attributes of an embedded SSME, mapped into four overarching domains: valued, integrated, permeable and effectively delivered. Stakeholder engagement in phase 2 progressed this to a priority ranked list of 11. In phase 3, four essential components attending to the prioritised attributes and forming the basis of the intervention were identified: 1) a clear marketing strategy for SSME; 2) a user friendly and effective referral pathway; 3) new/amended professional roles; and 4) a toolkit of resources.

Conclusions

NPT provides a flexible framework for synthesising evidence for the purpose of developing a complex intervention designed to increase and reduce variation in uptake to SSME programmes in primary care settings.

Available only for authorised users

It should be noted that the interventions of focus in the literature review were not necessarily SSME; rather, they were a range of interventions in primary care which had been developed or evaluated using NPT.

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Title: Using Normalisation Process Theory (NPT) to develop an intervention to improve referral and uptake rates for self-management education for patients with type 2 diabetes in UK primary care
Authors: Jessica Turner
Graham Martin
Nicky Hudson
Liz Shaw
Lisa Huddlestone
Christina Weis
Alison Northern
Sally Schreder
Melanie Davies
Helen Eborall
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Care
Type 2 Diabetes
Published in: BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-022-08553-7

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Using Normalisation Process Theory (NPT) to develop an intervention to improve referral and uptake rates for self-management education for patients with type 2 diabetes in UK primary care

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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