Development and Impact of a Community-Delivered, Multisectoral Lifestyle Management Service for People Living With Type 2 Diabetes (Logan Healthy Living): Protocol for a Pragmatic, Single-Arm Intervention Study.
Sjaan R Gomersall, Denis Y Giguere, Jacqueline Cotugno, Joanna Munro, Wallis J Westbrook, Robyn Littlewood, John Cairney, Elisabeth Ah Winkler, Phillip M van der Vliet, Ana D Goode, Tahlia Alsop, Genevieve Nissa Healy
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引用次数: 0
Abstract
Background: Type 2 diabetes is the fastest-growing chronic condition in Australia, with higher prevalence in disadvantaged groups. Logan Healthy Living by UQ Health Care is a proof-of-concept, interprofessional allied health clinic focused on supporting people with and at risk of type 2 diabetes in Logan, a region in South East Queensland, Australia, with high levels of health inequity. Logan Healthy Living is supported by the Queensland Government through Health and Wellbeing Queensland and a broader multisectoral alliance including primary health care; tertiary hospital and health services; and government, community, and university sectors.
Objective: This paper describes the establishment of Logan Healthy Living and outlines the evaluation protocol for the service's type 2 diabetes lifestyle management program.
Methods: The context and setting of Logan Healthy Living are presented, and the process for establishing the multisectoral partnerships, development and governance of the service, and the facility are described. The lifestyle management program is an 8-week, group-based program that includes 1 hour of education and 1 hour of supervised, individually tailored exercise each week. The theoretical underpinnings and the program are described in detail. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework will guide evaluation of the program and inform key questions regarding the number and characteristics of the clients (reach); diabetes-related distress, health behaviors (physical activity and diet), quality of life, self-management self-efficacy, loneliness, community involvement, anthropometric measures, hemoglobin A1c levels, physical function, and health care use (effectiveness); referral pathways (adoption); fidelity, appropriateness, acceptability, and costs (implementation); and long-term effectiveness (maintenance). Data will be drawn from a purposefully embedded minimum dataset and data registry, with the process for designing and embedding data collection into practice (via surveys, in-person measures, and client management software) described in detail.
Results: Ethics approval has been obtained for the data registry. Logan Healthy Living is a 4-year proof of concept that concludes on December 31, 2024, with findings expected to be reported starting in 2025.
Conclusions: While multisectoral responses are needed for complex community health challenges, the processes for achieving these are rarely documented, and the description of the development of Logan Healthy Living has the potential to inform future partnerships. The findings of the evaluation will provide important new knowledge on the impact of a community-delivered type 2 diabetes program on individuals, the community, and the health system in an area of high health inequity.
International registered report identifier (irrid): DERR1-10.2196/69477.
背景:2型糖尿病是澳大利亚增长最快的慢性疾病,在弱势群体中患病率更高。UQ Health Care的洛根健康生活是一个概念验证的跨专业联合健康诊所,专注于支持澳大利亚昆士兰州东南部洛根地区的2型糖尿病患者和有2型糖尿病风险的人,健康不平等程度很高。昆士兰州政府通过昆士兰州健康和福利以及包括初级保健在内的更广泛的多部门联盟支持Logan健康生活;三级医院和保健服务;以及政府、社区和大学部门。目的:本文描述了洛根健康生活的建立,并概述了该服务的2型糖尿病生活方式管理项目的评估方案。方法:介绍了洛根健康生活的背景和环境,并描述了建立多部门伙伴关系的过程、服务和设施的发展和治理。生活方式管理项目是一个为期8周的团体项目,包括每周1小时的教育和1小时的有监督的、量身定制的锻炼。详细介绍了该方法的理论基础和程序。Reach、有效性、采用、实施和维护(RE-AIM)框架将指导项目的评估,并告知有关客户数量和特征的关键问题(Reach);糖尿病相关的痛苦、健康行为(身体活动和饮食)、生活质量、自我管理自我效能、孤独感、社区参与、人体测量、血红蛋白A1c水平、身体功能和医疗保健使用(有效性);转诊途径(采用);忠实度、适当性、可接受性和成本(实施);且长期有效(维护)。数据将从有目的地嵌入的最小数据集和数据注册表中提取,并详细描述设计和嵌入数据收集的过程(通过调查,亲自测量和客户管理软件)。结果:已获得数据注册的伦理批准。Logan健康生活是一个为期4年的概念验证,将于2024年12月31日结束,预计将于2025年开始报告结果。结论:虽然需要多部门应对复杂的社区卫生挑战,但实现这些挑战的过程很少有文件记录,而对Logan健康生活发展的描述有可能为未来的伙伴关系提供信息。评估结果将提供重要的新知识,了解社区提供的2型糖尿病规划对个人、社区和卫生系统的影响,在一个高度卫生不平等的地区。国际注册报告标识符(irrid): DERR1-10.2196/69477。