Pavlidou, Antria; (2024) Development and feasibility study of a community pharmacy intervention to support self-management of patients with type 2 diabetes, in Cyprus. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: The pharmacists’ role has evolved over the past years towards a more clinical role to support patients in managing various prevalent health conditions. Cyprus had one of the highest prevalence of diabetes among other European countries in 2021. Motivational interviewing has been shown to be an effective tool in consultations. In recent years there has been increasing interest in the potential of mobile technologies in health care. However, effective implementation, management, and evaluation of those interventions aiming to improve type 2 diabetes self-management are still being researched. Aim: The aim of this study was to design and implement a mobile health intervention delivered by a pharmacist applying motivational interviewing techniques, aiming to improve the self-management of type 2 diabetes patients. Then, primarily evaluate its feasibility, acceptability, and secondary, participants’ medication adherence and self-care activity. Method: Type 2 diabetes patients visiting a diabetes clinic in Cyprus were recruited. The intervention included: pharmacist online advice to patient queries, tracking and uploading blood glucose readings, graphical reports, reminders, education, and optimization of pharmacotherapy delivered over an initial face-to-face consultation and up to 3 follow-up telephone appointments at maximum intervals of 6-8 weeks. Feasibility was measured by recruitment and retention, use and workability of the intervention, and basic costs. Participants’ and healthcare professionals’ acceptability was assessed via two semi-structured interview schedules based on the Theoretical Framework of Acceptability (Sekhon et al., 2017). Participants’ medication adherence and self-care activity were assessed by the adapted Diabetes Self-Care Activities Questionnaire - Greek version before and after the intervention (Intas et al., 2012). Results: Twenty-seven patients agreed to participate, of whom 22 completed the intervention. Participants communicated with the pharmacist and agreed to use, education, and the review of patients’ medications. A barrier to the intervention was the pharmacist accessing patients’ data, as HbA1c (69%) and blood glucose (90%) were not accessible to all participants. Based on the study findings, participants valued the motivational interview and pharmacist approach, while healthcare professionals highlighted the benefits of pharmacy service, specifically in increasing medication adherence. Participants reported improvements in self-care during the study period in three out of five domains (blood sugar testing, healthy eating, and foot care) assessed in the adapted DSCAQ – Greek version, whereas adherence to diabetes medications and physical activity remained the same. Conclusion: The results suggest that individualised, evidence-based digital health interventions delivered by a pharmacist can potentially support diabetes self-management in the context of health care for diabetes in Cyprus. Further extrapolating of the proposed intervention in larger settings is required to draw robust conclusions about the interventions’ cost-effectiveness.

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