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The DAFNEplus programme for sustained type 1 diabetes self management: Intervention development using the Behaviour

Stephanie H Stanton-Fay¹, Kathryn Hamilton¹, Paul M Chadwick¹

¹Clinical, Health and Educational Psychology/Centre for Behaviour Change, University College London, London, United Kingdom of Great Britain and Northern Ireland.

Diabetic Medicine : a Journal of the British Diabetic Association

|February 22, 2021

Summary

Revising the Dose Adjustment for Normal Eating (DAFNE) program using the Behaviour Change Wheel (BCW) framework improved type 1 diabetes self-management. The DAFNEplus intervention incorporated 27 new behavior change techniques to sustain long-term health outcomes.

Keywords:

Behaviour Change Wheel Type 1 diabetes behaviour change diabetes self-management education intervention revision

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Area of Science:

Behavioral science
Endocrinology
Public health

Background:

Type 1 diabetes self-management programs like DAFNE show short-term benefits but struggle with long-term behavior maintenance.
Sustaining behavioral changes is crucial for long-term clinical outcomes in type 1 diabetes management.

Purpose of the Study:

To revise the DAFNE intervention using the Behaviour Change Wheel (BCW) framework to enhance sustained behavior change in type 1 diabetes self-management.
To systematically identify barriers and enablers to self-management maintenance and integrate them into an updated intervention.

Main Methods:

A four-step BCW approach was used, involving stakeholder consultation, evidence synthesis, and mapping to the Capability, Opportunity, Motivation-Behaviour (COM-B) model.
Existing Dose Adjustment for Normal Eating (DAFNE) intervention's behavior change techniques (BCTs) were specified using the Behaviour Change Techniques Taxonomy (BCTTv1).
Additional BCTs were identified to target barriers, and recommendations were co-designed with stakeholders (diabetologists, psychologists, nurses, dieticians).

Main Results:

34 barriers and 5 enablers to sustaining self-management post-DAFNE were identified.
The original DAFNE intervention included 24 BCTs; 27 new BCTs were added, such as 'Habit formation' and 'Credible source'.
The revised DAFNEplus intervention comprises a group course, individual follow-ups, and technological support, incorporating 15 stakeholder-agreed recommendations.

Conclusions:

The BCW framework provided a systematic method for revising the DAFNE intervention, incorporating stakeholder input.
The revised DAFNEplus intervention is designed to support the maintenance of self-management behaviors by addressing identified barriers and enablers.
This systematic revision aims to improve long-term clinical outcomes for individuals with type 1 diabetes.