Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control

Abstract Background The Barbados Diabetes Remission Study-2 reported that a low-calorie diet for weight loss and diabetes remission implemented within the community and supported by trained community health advocates was both an acceptable implementation strategy and a clinically effective intervent...

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Main Authors: Kim R. Quimby, Madhuvanti M. Murphy, Heather Harewood, Christina Howitt, Ian Hambleton, Selvi M. Jeyaseelan, Natalie Greaves, Natasha Sobers
Format: Article
Language:English
Published: BMC 2022-01-01
Series:Implementation Science Communications
Subjects:
Online Access:https://doi.org/10.1186/s43058-022-00255-9
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author Kim R. Quimby
Madhuvanti M. Murphy
Heather Harewood
Christina Howitt
Ian Hambleton
Selvi M. Jeyaseelan
Natalie Greaves
Natasha Sobers
author_facet Kim R. Quimby
Madhuvanti M. Murphy
Heather Harewood
Christina Howitt
Ian Hambleton
Selvi M. Jeyaseelan
Natalie Greaves
Natasha Sobers
author_sort Kim R. Quimby
collection DOAJ
description Abstract Background The Barbados Diabetes Remission Study-2 reported that a low-calorie diet for weight loss and diabetes remission implemented within the community and supported by trained community health advocates was both an acceptable implementation strategy and a clinically effective intervention. This study aimed to examine the adaptability of the face-to-face protocol into an online modality. Methods The Iterative Decision-making for Evaluation of Adaptations (IDEA) framework guides researchers in examining the necessity of the adaptation and the preservation of core intervention elements during the adaptation process. Adaptation outcomes were documented using the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). Implementation outcome was determined by fidelity to core elements. Intervention effectiveness was determined from the analysis of clinical data. Results We decided that an adaptation was needed as COVID-19 control measures prohibited in-person interactions. The core elements—i.e. 12-week intervention duration, daily 840-kcal allowance, and weekly monitoring of weight and blood glucose—could be preserved during the adaptation process. Adaptations were made to the following: (1) the context in which data were collected—participants self-measured at home instead of following the original implementation strategy which involved being measured by community health advocates (CHA) at a community site; (2) the context in which data were entered—participants posted their measurements to a mobile application site which was accessible by CHAs. As with the original protocol, CHAs then entered the measurements into an online database; (3) the formulation of the low-calorie diet—participants substituted the liquid formulation for a solid meal plan of equivalent caloric content. There was non-inferiority in fidelity to attendance with the online format (97.5% visit rate), as compared to the face-to-face modality (95% visit rate). One participant deviated from the calorie allowances citing difficulty in estimating non-exact portion sizes and financial difficulty in procuring meals. Weight change ranged from − 14.3 to 0.4 kg over the 12-week period, and all group members achieved induction of diabetes remission as determined by a FBG of < 7mmol/l and an A1C of < 6.5%. Conclusion The results suggest that this adapted online protocol—which includes changes to both the implementation strategy and the evidence-based practice—is clinically effective whilst maintaining fidelity to key elements. Utilization of the IDEA and FRAME-IS adaptation frameworks add scientific rigour to the research. Trial registration ClinicalTrials.gov NCT03536377 . Registered on 24 May 2018
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spelling doaj.art-729eba66e7b249bc9044afa88d718da42022-12-21T17:25:47ZengBMCImplementation Science Communications2662-22112022-01-01311810.1186/s43058-022-00255-9Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take controlKim R. Quimby0Madhuvanti M. Murphy1Heather Harewood2Christina Howitt3Ian Hambleton4Selvi M. Jeyaseelan5Natalie Greaves6Natasha Sobers7The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West IndiesThe George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West IndiesThe Faculty of Medical Sciences, The University of the West IndiesThe George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West IndiesThe George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West IndiesThe Faculty of Medical Sciences, The University of the West IndiesThe Faculty of Medical Sciences, The University of the West IndiesThe George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West IndiesAbstract Background The Barbados Diabetes Remission Study-2 reported that a low-calorie diet for weight loss and diabetes remission implemented within the community and supported by trained community health advocates was both an acceptable implementation strategy and a clinically effective intervention. This study aimed to examine the adaptability of the face-to-face protocol into an online modality. Methods The Iterative Decision-making for Evaluation of Adaptations (IDEA) framework guides researchers in examining the necessity of the adaptation and the preservation of core intervention elements during the adaptation process. Adaptation outcomes were documented using the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). Implementation outcome was determined by fidelity to core elements. Intervention effectiveness was determined from the analysis of clinical data. Results We decided that an adaptation was needed as COVID-19 control measures prohibited in-person interactions. The core elements—i.e. 12-week intervention duration, daily 840-kcal allowance, and weekly monitoring of weight and blood glucose—could be preserved during the adaptation process. Adaptations were made to the following: (1) the context in which data were collected—participants self-measured at home instead of following the original implementation strategy which involved being measured by community health advocates (CHA) at a community site; (2) the context in which data were entered—participants posted their measurements to a mobile application site which was accessible by CHAs. As with the original protocol, CHAs then entered the measurements into an online database; (3) the formulation of the low-calorie diet—participants substituted the liquid formulation for a solid meal plan of equivalent caloric content. There was non-inferiority in fidelity to attendance with the online format (97.5% visit rate), as compared to the face-to-face modality (95% visit rate). One participant deviated from the calorie allowances citing difficulty in estimating non-exact portion sizes and financial difficulty in procuring meals. Weight change ranged from − 14.3 to 0.4 kg over the 12-week period, and all group members achieved induction of diabetes remission as determined by a FBG of < 7mmol/l and an A1C of < 6.5%. Conclusion The results suggest that this adapted online protocol—which includes changes to both the implementation strategy and the evidence-based practice—is clinically effective whilst maintaining fidelity to key elements. Utilization of the IDEA and FRAME-IS adaptation frameworks add scientific rigour to the research. Trial registration ClinicalTrials.gov NCT03536377 . Registered on 24 May 2018https://doi.org/10.1186/s43058-022-00255-9Community interventionOnline interventionAdaptationModificationFidelitySelf-monitor
spellingShingle Kim R. Quimby
Madhuvanti M. Murphy
Heather Harewood
Christina Howitt
Ian Hambleton
Selvi M. Jeyaseelan
Natalie Greaves
Natasha Sobers
Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
Implementation Science Communications
Community intervention
Online intervention
Adaptation
Modification
Fidelity
Self-monitor
title Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
title_full Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
title_fullStr Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
title_full_unstemmed Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
title_short Adaptation of a community-based type-2 diabetes mellitus remission intervention during COVID-19: empowering persons living with diabetes to take control
title_sort adaptation of a community based type 2 diabetes mellitus remission intervention during covid 19 empowering persons living with diabetes to take control
topic Community intervention
Online intervention
Adaptation
Modification
Fidelity
Self-monitor
url https://doi.org/10.1186/s43058-022-00255-9
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