A qualitative exploration of the acceptability of a supported self‐management intervention for people with type 2 diabetes and severe mental illness

Background

People with severe mental illness (SMI) are twice as likely to develop Type 2 diabetes (T2D) compared with people without SMI and have poorer outcomes from T2D. Research evaluating self-management interventions for T2D consistently excludes individuals with SMI, therefore existing offers fail to address the specific needs of this population. The DIAMONDS programme (Diabetes and Mental Illness, Improving Outcomes and Self-management) developed a bespoke supported self-management programme for people with coexisting SMI and T2D.

Methods

As part of a mixed-methods feasibility study we collected and analysed qualitative data to explore the acceptability of the DIAMONDS intervention. Semi-structured interviews were conducted with 12 service user participants with SMI and T2D, and 10 DIAMONDS Coaches who delivered the intervention. Interviews were informed by the theoretical framework of acceptability and were thematically analysed.

Results

Four overarching themes were identified, these included: Recognising and addressing a need—highlighting the importance of the intervention in the context of current gaps in care; ‘It’s all about person-centred, essentially, isn’t it?’—emphasising the role of flexible, individualised delivery in acceptability; Utility of different intervention components—describing how different components were used; Tangible change and beneficial effects— improvements in behaviour and health, including smoking cessation.

Discussion

The DIAMONDS intervention was acceptable for people with SMI and T2D and for DIAMONDS Coaches who were delivering it. A person-centred approach enabled engagement and self-reported behaviour change, but participants needed differing levels of support for behaviour change. These findings informed refinements to the intervention, which will be evaluated in a definitive trial.