Behaviour change in diabetes: behavioural science advancements to support the use of theory.

Behaviour is central to the management of diabetes, both for people living with diabetes and for healthcare professionals delivering evidence-based care. This review outlines the evolution of behavioural science and the application of theoretical models in diabetes care over the past 25 years. There has been a particular advancement in the development of tools and techniques to support researchers, healthcare professionals and policymakers in taking a theory-based approach, and to enhance the development, reporting and replication of successful interventions. Systematic guidance, theoretical frameworks and lists of behavioural techniques provide the tools to specify target behaviours, identify why ideal behaviours are not implemented, systematically develop theory-based interventions, describe intervention content using shared terminology, and evaluate their effects. Several examples from a range of diabetes-related behaviours (clinic attendance, self-monitoring of blood glucose, retinal screening, setting collaborative goals in diabetes) and populations (people with type 1 and type 2 diabetes, healthcare professionals) illustrate the potential for these approaches to be widely translated into diabetes care. The behavioural science approaches outlined in this review give healthcare professionals, researchers and policymakers the tools to deliver care and design interventions with an evidence-based understanding of behaviour. The challenge for the next 25 years is to refine the tools to increase their use and advocate for the role of theoretical models and behavioural science in the commissioning, funding and delivery of diabetes care.

'It's an important part, but I am not quite sure that it is working': educators' perspectives on the implementation of goal-setting within the 'DAFNE' diabetes structured education programme.

AIM: To explore educators' perspectives on the implementation of goal-setting and action-planning strategies within a structured diabetes self-management education programme. METHODS: Ten semi-structured interviews were conducted with diabetes self-management education providers delivering the 'Dose Adjustment for Normal Eating' (DAFNE) programme to people with Type 1 diabetes throughout Ireland. A pre-designed topic guide, focused on exploring educators' experiences of delivery and application and views on usefulness of goal-setting strategies, was used in all interviews. The interviews were recorded, transcribed and analysed using thematic analysis. RESULTS: Five main themes were identified: 'people need a plan', discussing perspectives on goal-setting's value; 'the power of the group', highlighting the impact a group format has on goal-setting practices; 'diversity and individuality', discussing differences in DAFNE participants' and educators' engagement with goal-setting; 'goal-setting's fit', exploring perspectives on how well goal-setting fits within diabetes self-management education and follow-up care; and 'feelings of inadequate psychological knowledge', addressing challenges experienced in the delivery of goal-setting components. CONCLUSION: While educators saw benefits in the implementation of goal-setting and planning strategies within diabetes self-management education, concerns about how well goal-setting currently fits within diabetes self-management education and follow-up care were evident. Additionally, many educators experienced the delivery of goal-setting and action-planning strategies as challenging and would value additional training opportunities.