Feasibility of type 2 diabetes prevention : processes for detection, self-management and support in socioeconomically disadvantaged areas

Background: Type 2 diabetes (T2D) is on the rise globally, affecting disadvantaged populations to a higher extent. Both T2D and prediabetes are often undiagnosed. Early detection of T2D and prediabetes is of importance to avoid complications due to metabolic disturbances caused by elevated glucose values. Self-management support and lifestyle interventions to manage and prevent diabetes have proven to be effective strategies in high income settings.

Aim: To determine the feasibility of early detection and implementation of a self-management support intervention for T2D and persons at risk in socioeconomically disadvantaged areas in Stockholm.

Methods: Mixed methods were utilized. In study 1, 15 qualitative interviews were conducted with persons living with a high risk of developing diabetes over a period of ten years. The data were analyzed using qualitative content analysis. Study 2 compared data from community screening and facility-based screening generated from 2,564 participants to investigate screening reach using descriptive statistics. In study 3 a tool was developed to assess participant satisfaction of a telephone-facilitated health coaching intervention. Study 4 consisted of testing a tool to understand different dimensions of interaction between facilitators and participants in the health coaching intervention. Interaction scoring was performed and thematic analysis applied on quality assurance meetings with facilitators. Exploratory factor analyses were conducted for both study 3 and study 4 for tool development and interpretation of results.

Results: The main theme developed from the qualitative interviews was that the risk of T2D is not concrete enough to motivate lifestyle modification without other external triggers. Persons born in Africa and Asia were reached to a higher extent through community screening, while persons born in Sweden and other European countries were reached more through facility-based screening. Participants reported the health coaching intervention as acceptable, although the perceived burden was higher among younger individuals and those at high risk compared to participants with T2D. Differences in coaching styles were found between facilitators in intervention delivery, particularly in goal setting, and limitations in language skills were a hinder in the communication between facilitators and participants.

Conclusions: The potential of reversing diabetes and prediabetes should be highlighted and more clearly defined to serve as motivators for lifestyle modification. Community- and facilitybased screening are complementary methods in reaching people at high risk. Telephonefacilitated health coaching is an acceptable support intervention in socioeconomically disadvantaged population groups and should be considered when planning prevention and management strategies. Tailoring the intervention to meet participant needs is important and language skilled facilitators are needed to reduce hinders in intervention delivery.

List of scientific papers

I. Timm L, Daivadanam M, Lager A, Forsberg B, Östenson CG, Mölsted Alvesson H. "I Did Not Believe You Could Get Better" - Reversal of Diabetes Risk Through Dietary Changes in Older Persons with Prediabetes in Region Stockholm. Nutrients. 2019;11(11): 2658.
https://doi.org/10.3390/nu11112658

II. Timm L, Harcke K, Karlsson I, Sidney Annerstedt K, Alvesson HM, Stattin NS, Forsberg BC, Östenson CG, Daivadanam M. Early detection of type 2 diabetes in socioeconomically disadvantaged areas in Stockholm - Comparing reach of community and facility-based screening. Global health action. 2020;13(1):1795439.
https://doi.org/10.1080/16549716.2020.1795439

III. Timm L, Sidney Annerstedt K, Álvarez Ahlgren J, Absetz P, Alvesson HM, Forsberg BC, Daivadanam M. Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes. [Submitted]

IV. Timm L, Karlsson I, Sidney Annerstedt K, Absetz P, Forsberg BC, Daivadanam M, Alvesson HM. Understanding dimensions of interaction between participants and facilitators in a telephone-facilitated health coaching intervention for diabetes care and prevention. [Manuscript]