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Developing and evaluating a diabetes self-management education intervention for people with severe mental illness

The overall aim of this project is to develop and test a bespoke educational package to help people with severe mental illness and diabetes to manage their diabetes better.

Diabetes is more than twice as common in people with severe mental illness and has poorer outcomes than the general population. In England, around 44,000 people live with both conditions, (15% of all people with severe mental illness). Poor diabetes management leads to complications including heart disease, stroke, eye and kidney disease and premature death, and contributes significantly to the lower life expectancy for people with severe mental illness.

Self-management, the process by which people learn to manage a chronic illness, is the cornerstone of good diabetes care. Self-management education goes beyond traditional methods of patient education, to build problem-solving and self-efficacy skills, crucial to self-management. Self-management education is effective in increasing an individual’s ability to manage their health, improving physical and mental health, and reducing healthcare costs for diabetes. People with severe mental illness often miss out on self-management education that has been developed for the general population. This is because mental illness may affect capacity to participate and there may be additional barriers to accessing generic programmes. Tailored diabetes self-management education is needed that targets the specific barriers that people with severe mental illness face.

First, we will learn what influences successful self-management of diabetes in people with severe mental illness through literature review and interviews with patients, carers and healthcare staff. Second, we will use this information to design a bespoke self-management education package, using 'co-design' workshops. Co-design is the process whereby end-users and healthcare professionals jointly design interventions. Technology experts will also be involved in these workshops to help develop a mobile phone or Internet-based application to complement the education package. Third, in a trial, we will test effectiveness of the bespoke intervention (which we are calling 'DIAMONDS' (Diabetes and Mental Illness Improving Outcomes and Self-management), in improving a person's ability to manage their condition, health outcomes and healthcare costs. We will use a method that will randomly allocate half of the participants to DIAMONDS and half to usual care. We will also estimate long-term impact of DIAMONDS on health and costs by building a model that can predict these from information obtained within the trial. Finally, we will explore wider generalisability of the issues we identify for self-management in people with SMI, by using our findings to adapt an intervention for another chronic condition.

The development grant will help strengthen our research team, select measures that can be used to assess how well the intervention works, and identify elements of generic diabetes education programmes that could be adapted, in preparation for our planned research programme.