Hau Yi Ngan , Yuen Yu Chong , Kit Man Loo , Wai Tong Chien
{"title":"基于接受度的糖尿病教育（ACT-DE）计划对2型糖尿病患者糖尿病困扰和自我护理行为的初步疗效：一项试点随机对照试验","authors":"Hau Yi Ngan , Yuen Yu Chong , Kit Man Loo , Wai Tong Chien","doi":"10.1016/j.jcbs.2023.09.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Diabetes distress is often characterised by aversive feelings about diabetes and avoidance of diabetes self-care, leading to suboptimal blood glucose<span><span> control, diabetes complications and depression. Evidence from a recent review has indicated the potential efficacy of acceptance-based diabetic self-management programmes for improving blood glucose levels and </span>mental health outcomes by fostering psychological flexibility.</span></p></div><div><h3>Methods</h3><p>We conducted a two-arm and assessor-blinded pilot randomised controlled trial<span> (RCT) with 48 participants aged 18–64 with type 2 diabetes and moderate distress levels, in which we compared a 6-week acceptance and commitment therapy and diabetes education (ACT-DE) programme intervention with diabetes education. Diabetes distress (the primary outcome), self-care behaviour, self-efficacy in diabetes management, and psychological inflexibility were measured at baseline and post-intervention. Focus group interviews were conducted to explore the intervention group's perceptions of the benefits and limitations of the intervention.</span></p></div><div><h3>Results</h3><p><span>Results of ANCOVA test showed that the intervention group exhibited significantly greater decrease in diabetes distress (effect size [Cohen's </span><em>d</em>] = 0.65), and increase in exercise frequency (<em>d</em> = 1.16), and foot-care frequency (<em>d</em><span> = 0.59) than the diabetes education group. The qualitative feedback of the intervention group revealed that the learnt ACT skills can be effectively applied in self-care and highlighted the utility of some of the intervention's therapeutic components, primarily mindfulness practices, metaphors, and interactive diabetes education. The intervention was well-accepted, with an 87.5% completion rate, but caution is needed due to a low recruitment rate (28.1%) during COVID-19 pandemic peak.</span></p></div><div><h3>Conclusion</h3><p>This pilot study confirmed that ACT-DE programme is an acceptable intervention for people with type 2 diabetes. It demonstrated preliminary efficacy with medium-to-large effect sizes in alleviating the participants’ diabetes distress and improving their self-care. Recruitment strategies can be improved to enhance the feasibility. Moreover, a full-scale RCT with longer-term follow-up is warranted to examine the intervention effects on diabetes distress, blood glucose control and other health outcomes.</p></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"30 ","pages":"Pages 50-60"},"PeriodicalIF":3.4000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preliminary efficacy of an acceptance-based diabetes education (ACT-DE) programme for people with type 2 diabetes on diabetes distress and self-care behaviours: A pilot randomised controlled trial\",\"authors\":\"Hau Yi Ngan , Yuen Yu Chong , Kit Man Loo , Wai Tong Chien\",\"doi\":\"10.1016/j.jcbs.2023.09.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Diabetes distress is often characterised by aversive feelings about diabetes and avoidance of diabetes self-care, leading to suboptimal blood glucose<span><span> control, diabetes complications and depression. Evidence from a recent review has indicated the potential efficacy of acceptance-based diabetic self-management programmes for improving blood glucose levels and </span>mental health outcomes by fostering psychological flexibility.</span></p></div><div><h3>Methods</h3><p>We conducted a two-arm and assessor-blinded pilot randomised controlled trial<span> (RCT) with 48 participants aged 18–64 with type 2 diabetes and moderate distress levels, in which we compared a 6-week acceptance and commitment therapy and diabetes education (ACT-DE) programme intervention with diabetes education. Diabetes distress (the primary outcome), self-care behaviour, self-efficacy in diabetes management, and psychological inflexibility were measured at baseline and post-intervention. Focus group interviews were conducted to explore the intervention group's perceptions of the benefits and limitations of the intervention.</span></p></div><div><h3>Results</h3><p><span>Results of ANCOVA test showed that the intervention group exhibited significantly greater decrease in diabetes distress (effect size [Cohen's </span><em>d</em>] = 0.65), and increase in exercise frequency (<em>d</em> = 1.16), and foot-care frequency (<em>d</em><span> = 0.59) than the diabetes education group. The qualitative feedback of the intervention group revealed that the learnt ACT skills can be effectively applied in self-care and highlighted the utility of some of the intervention's therapeutic components, primarily mindfulness practices, metaphors, and interactive diabetes education. The intervention was well-accepted, with an 87.5% completion rate, but caution is needed due to a low recruitment rate (28.1%) during COVID-19 pandemic peak.</span></p></div><div><h3>Conclusion</h3><p>This pilot study confirmed that ACT-DE programme is an acceptable intervention for people with type 2 diabetes. It demonstrated preliminary efficacy with medium-to-large effect sizes in alleviating the participants’ diabetes distress and improving their self-care. Recruitment strategies can be improved to enhance the feasibility. Moreover, a full-scale RCT with longer-term follow-up is warranted to examine the intervention effects on diabetes distress, blood glucose control and other health outcomes.</p></div>\",\"PeriodicalId\":47544,\"journal\":{\"name\":\"Journal of Contextual Behavioral Science\",\"volume\":\"30 \",\"pages\":\"Pages 50-60\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2023-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Contextual Behavioral Science\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2212144723001114\",\"RegionNum\":3,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Contextual Behavioral Science","FirstCategoryId":"102","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212144723001114","RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
Preliminary efficacy of an acceptance-based diabetes education (ACT-DE) programme for people with type 2 diabetes on diabetes distress and self-care behaviours: A pilot randomised controlled trial
Background
Diabetes distress is often characterised by aversive feelings about diabetes and avoidance of diabetes self-care, leading to suboptimal blood glucose control, diabetes complications and depression. Evidence from a recent review has indicated the potential efficacy of acceptance-based diabetic self-management programmes for improving blood glucose levels and mental health outcomes by fostering psychological flexibility.
Methods
We conducted a two-arm and assessor-blinded pilot randomised controlled trial (RCT) with 48 participants aged 18–64 with type 2 diabetes and moderate distress levels, in which we compared a 6-week acceptance and commitment therapy and diabetes education (ACT-DE) programme intervention with diabetes education. Diabetes distress (the primary outcome), self-care behaviour, self-efficacy in diabetes management, and psychological inflexibility were measured at baseline and post-intervention. Focus group interviews were conducted to explore the intervention group's perceptions of the benefits and limitations of the intervention.
Results
Results of ANCOVA test showed that the intervention group exhibited significantly greater decrease in diabetes distress (effect size [Cohen's d] = 0.65), and increase in exercise frequency (d = 1.16), and foot-care frequency (d = 0.59) than the diabetes education group. The qualitative feedback of the intervention group revealed that the learnt ACT skills can be effectively applied in self-care and highlighted the utility of some of the intervention's therapeutic components, primarily mindfulness practices, metaphors, and interactive diabetes education. The intervention was well-accepted, with an 87.5% completion rate, but caution is needed due to a low recruitment rate (28.1%) during COVID-19 pandemic peak.
Conclusion
This pilot study confirmed that ACT-DE programme is an acceptable intervention for people with type 2 diabetes. It demonstrated preliminary efficacy with medium-to-large effect sizes in alleviating the participants’ diabetes distress and improving their self-care. Recruitment strategies can be improved to enhance the feasibility. Moreover, a full-scale RCT with longer-term follow-up is warranted to examine the intervention effects on diabetes distress, blood glucose control and other health outcomes.
期刊介绍：
The Journal of Contextual Behavioral Science is the official journal of the Association for Contextual Behavioral Science (ACBS).
Contextual Behavioral Science is a systematic and pragmatic approach to the understanding of behavior, the solution of human problems, and the promotion of human growth and development. Contextual Behavioral Science uses functional principles and theories to analyze and modify action embedded in its historical and situational context. The goal is to predict and influence behavior, with precision, scope, and depth, across all behavioral domains and all levels of analysis, so as to help create a behavioral science that is more adequate to the challenge of the human condition.
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