Emotional Wellbeing In Diabetes: Version 1
Research type
Research Study
Full title
Investigating the care that people with diabetes receive for their emotional wellbeing.
IRAS ID
301444
Contact name
Joanna Hudson
Contact email
Sponsor organisation
King's College London
Clinicaltrials.gov Identifier
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Research summary
Psychological distress within DM is common and it is well known that this psychological distress can impact upon physical health outcomes for people with DM. This suggests that psychological treatment is needed to combat this double burden. Cognitive behavioural therapy (CBT) is the preferred treatment option for psychological health within DM. "COMPASS - navigating your long-term condition" is an existing digital CBT treatment that has been developed at King's College London. COMPASS is currently the only evidence based digital CBT intervention being used to treat anxiety and/or depression trans-diagnostically across long term conditions (LTCs). However, the utility of COMPASS for people with DM has not yet been tested. Further, the effectiveness of COMPASS has been assessed in other LTCs within a randomised controlled trial (RCT), but this was in a controlled research environment and uncertainties remain about whether it is feasible and acceptable to implement COMPASS in routine NHS care.
Therefore, the main objective of this study is to conduct a feasibility and acceptability study to describe the implementation context of COMPASS in routine NHS care whilst also examining pre-post change scores on mental, psychosocial, and physical outcomes. The outcomes of this study will inform the design of a full- scale effectiveness-implementation trial. Eligible participants will be individuals with DM and co-morbid psychological distress identified within routine care. The study will last approx. 9 months in total and will involve participants completing questionnaires at 0, 12 weeks and 6 months. Participants will also be invited to take part in a qualitative interview. Healthcare professionals will also be invited to interview.
Participants will be recruited from NHS sites: Improving Access to Psychological Therapies (IAPT) community clinics within South London and Maudsely NHS trust and Homerton NHS trust and from outpatient diabetes clinics attached to Guys and St Thomas NHS trust (GSTT).
Summary Results
We utilized a mixed methods approach along with the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) developed by Glasgow, Vogt, & Boles (1999) to assess the feasibility of integrating COMPASS, a therapist-supported internet-enabled CBT program, into routine care for adults with diabetes across two settings: Primary Care Talking Therapies and a secondary care diabetes services.
Regarding Reach, we observed a low conversion rate of individuals with diabetes (PwD) referred for psychological support to those willing to use COMPASS, with a conversion rate of 20% (8/41) in the diabetes service and 0.7% (6/777) in Talking Therapy services. However, due to missing data in clinical records, we were unable to determine if the reasons for this poor reach, whether due to ineligibility or lack of acceptability. Qualitative interview findings suggested that integrated care settings might enhance uptake, although further efforts are necessary to elucidate the value of digital therapies and COMPASS specifically in both settings.
In terms of Effectiveness, our findings indicate promising pre-post treatment trends suggesting that COMPASS is effective in improving mental health and psychosocial outcomes for PwD in routine care. Further potential benefits for HbA1c improvement were identified. However, qualitative findings revealed a desire among PwD for more emphasis on self-management aspects of diabetes.
Regarding Implementation, overall usage rates of online and therapist support sessions were low. However, more online and therapist sessions were completed in the diabetes service compared to Talking Therapies. Therapists in the diabetes service also spent more time supporting patients compared to those in Talking Therapies. Usage by patients and therapists fell short of the intended protocol, with qualitative findings indicating dissatisfaction among some PwD regarding therapist support.
We also interviewed healthcare professionals who worked in or alongside one of the health care services implementing COMPASS. Participants included therapists, trainee therapists, service leads, medical doctors, nurses, service commissioners or policy makers.
Our qualitative findings highlighted that participants acknowledged the need for scalable psychological treatment and recognized digital as one way to do this. However, barriers and facilitators to implementing COMPASS were multi-layered and existed at the patient, therapist, service, and system-level. Interviews generated themes highlighting these barriers and facilitators including 1) Perception of personal and systemic ability to provide psychological support to PwD, 2) Using COMPASS within the practical constraints of current care, 3) Patient barriers and facilitators to uptake and engagement.
REC name
Wales REC 5
REC reference
22/WA/0017
Date of REC Opinion
8 Feb 2022
REC opinion
Further Information Favourable Opinion