Dr Reidy is a chartered Psychologist and Implementation Scientist whose research is primarily in the development, evaluation and implementation of digital health interventions to support people with long-term conditions to self-manage across a number of clinical areas, especially people living with diabetes. Claire has a particular interest in understanding and supporting self-management strategies, and the role of social networks and social support in relation to living with diabetes. Address: Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford. OX2 6GG
BackgroundThe NHS App was launched as a ‘front door’ to digitally enabled health services, offeri... more BackgroundThe NHS App was launched as a ‘front door’ to digitally enabled health services, offering a range of services including appointment booking and ordering prescriptions. The extent of App use and its impacts on digital inclusion is under-explored.AimTo evaluate patterns of App uptake and adoption among different population groups.MethodInterrupted time series analyses explored aggregate monthly App usage from January 2019 - May 2021. Regression model assessed differences in App registration by markers of GP level socio-demographic variables. Qualitative interviews and focus groups involving 83 participants were conducted and analysed thematically.ResultsThere were 8,524,882 App downloads and 4,449,869 registrations. Negative binomial models found 25% less registrations in the most deprived practices (P<0.001) and 44% more registrations in the largest practices (P<0.001). Registration was 36% more in practices with the highest percentage of White patients (P<0.001) a...
Background Internet of Things (IoT) innovations such as wearables and sensors promise improved he... more Background Internet of Things (IoT) innovations such as wearables and sensors promise improved health outcomes and service efficiencies. Yet, most applications remain experimental with little routine use in health and care settings. We sought to examine the multiple interacting influences on IoT implementation, spread and scale-up, including the role of regional innovation ‘ecosystems’ and the impact of the COVID-19 context. Methods Qualitative study involving 20 participants with clinical, entrepreneurial and broader innovation experience in 18 in-depth interviews, focusing primarily on heart monitoring and assistive technology applications. Data analysis was informed by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework. Results Interviewees discussed multiple tensions and trade-offs, including lack of organisational capacity for routine IoT use, limited ability to receive and interpret data, complex procurement and governance processes, and risk of ...
Background The availability, affordability and utilisation of commercially available self-monitor... more Background The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patient-generated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices. Methods Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January–September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiology-affiliated clinicians at the same NHS Trust. Results Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the fi...
Good self-management (SM) of Type 1 diabetes (T1D) has the potential to avoid or delay life-threa... more Good self-management (SM) of Type 1 diabetes (T1D) has the potential to avoid or delay life-threatening and life-limiting complications and improve quality of life, yet is characterised by a demanding, multi-component regimen. The use of insulin pump therapy is growing internationally and has been posited as a way to support better SM of T1D. However, as a complex new technology unique challenges are faced, including complicated requirements for troubleshooting, incorporation and adaptation and carrying an object on the body 24/7. Providing people with SM support to incorporate this technology could improve the lives of people with T1D. However, the dominating biomedical approach to treatment of T1D and incorporation of insulin pump therapy is not enabling appropriate SM. In response, this thesis explores the SM needs of this population and tests a new approach to SM support which is sensitised to a social network approach, underpinned by Social Cognitive Theory. This approach could...
BACKGROUND Type 1 diabetes (T1D) is an autoimmune disease requiring intensive self-management (SM... more BACKGROUND Type 1 diabetes (T1D) is an autoimmune disease requiring intensive self-management (SM). An insulin pump (a new health technology) is designed to better support personal T1D management but at the same time exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social-support and resources from online interventions which offer flexible, innovative and accessible SM. However, questions remain as to which behaviour change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions from both patients and healthcare professionals (HCPs). OBJECTIVE The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist HCPs pertaining to a web-based social network (SN) intervention to support SM and determine what behaviour change characteristics and str...
Background: The availability, affordability and utilisation of commercially available self-monito... more Background: The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patientgenerated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices. Methods: Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January-September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiologyaffiliated clinicians at the same NHS Trust. Results: Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the first Covid-19 lockdown in England, from 8.3% to 16.6% (p < 0.001). In 127/185 (69%) cases self-monitored data were found to: provide or facilitate cardiac diagnoses (34/127); assist management of previously diagnosed cardiac conditions (55/127); be deployed for cardiovascular prevention (16/127); or be recommended for heart rhythm evaluation (10/127). In 58/185 (31%) cases clinicians did not put the self-monitored data to any evident use and in 12/185 (6.5%) cases patient-generated data prompted an unnecessary referral. In interviews and discussions, clinicians expressed mixed views on patient-generated data but foresaw a need to embrace and plan for this information flow, and proactively address challenges with integration into traditional care pathways. Conclusions: This study suggests patient-generated data are being used for clinical decision-making in ad hoc and opportunistic ways. Given shifts towards remote monitoring in clinical care, accelerated by the pandemic, there is a need to consider how best to incorporate patient-generated data in clinical processes, introduce relevant training, pathways and governance frameworks, and manage associated risks.
ObjectivesThis study aimed to evaluate patterns of uptake and adoption of the NHS App. Data metri... more ObjectivesThis study aimed to evaluate patterns of uptake and adoption of the NHS App. Data metrics from the NHS App were used to assess acceptability by looking at total app downloads, registrations, appointment bookings, GP health records viewed, and prescriptions ordered. The impact of the UK COVID-19 lockdown and introduction of the COVID Pass were also explored to assess App usage and uptake.MethodsDescriptive statistics and an interrupted time series analysis were used to look at monthly NHS App metrics at a GP practice level from January 2019-May 2021 in the population of England. Interrupted time series models were used to identify changes in level and trend among App usage and the different functionalities before and after the first COVID-19 lockdown. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting and analysis.ResultsBetween January 2019 and May 2021, there were a total of 8,524,882 NHS App downloads and ...
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recom... more Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOCX 121 kb)
Background: Mixed outcomes and national geographical variations in short and long-term psychologi... more Background: Mixed outcomes and national geographical variations in short and long-term psychological and biomedical benefits of continuous subcutaneous insulin infusion (CSII) have led The University Hospital Southampton (UHS) CSII service (conceived in 2014) to develop a new approach to care; The SPANGLE Model. SPANGLE: Southampton’s patient-orientated approach emphasizes Pump education which is All-inclusive and Non-judgmental. The focus is on Group work which is tailored according to the Life-events and needs patients using this service. Using E-health is also key, running virtual clinics (via email, telephone and texts) to provide a flexible and accessible service. Aim: To assess the impact of insulin pumps on patient outcomes in the context of a relatively new and forward-thinking clinic. Methods: Data were collected from n=90 patients who began CSII therapy at UHS. &gt;6 months ago. Baseline HbA1c, Problem Areas In Diabetes (PAID) and CLARKE hypoglycaemia awareness survey results were compared to 6 months, 1, 2, 3, and 4 years post-pump therapy. Results: Participants had a Mean age of 42.28 ±14 (range 21-77) diagnosis of 21.2 years ±12.40 (1-49 years) and n=55 (61.1%) were Female. A baseline Mean HbA1c of 69mmol/mol±13 (8.5%) reduced significantly to 60mmol/mol±11 (7.6%) at 6 months, (p &lt;0.001), 60mmol/mol±11 (7.6%) at 1 year (p &lt;0.001), 61mmol/mol±13 (7.7%) at 2 years, (p &lt; 0.001), and to 62mmol/mol±11 (7.8%) at 3 years (p &lt; 0.001). HbA1c was still reduced up to 4 years on but results were not statistically significant (lack of statistical power due to low numbers of patients). Baseline PAID scores (32.75± 21) decreased significantly at 6 months (20 ± 17) (p &lt; 0.001) and 1 year (19 ± 16) (p &lt; 0.05). PAID scores continued to be lower at 2 and 3 years than baseline but not significantly (due to low questionnaire response rates). Hypoglycaemia awareness improved from 65% of patients at baseline to 82% (6 months), 88% (1 year) and 92% (2 years) (low survey response rates &gt;2 years). Conclusion: Early evaluations of this patient-orientated clinic are promising due to sustained improvements in glycaemic control, hypoglycaemia awareness and diabetes-related distress. . Future work will focus on whether these results continue to sustain over a longer period and the particular factors that lead to improvements. Uptake of new technologies have increased especially in relation to Flash Glucose Monitoring (available on prescription locally) and Continuous Glucose Monitoring. The service needs to examine how this might impact on patient needs and outcomes.
Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-suppo... more Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-support group ‘Sugar buddies’. It grew from a local need for more information and peer-support for people with Type 1 diabetes (T1D). The event covered; Managing sport and exercise Getting the most from appointments Your local Parkrun The psychological impact of diabetes and managing burnout Technology and beyond (Libre, CGMs, pumps, open/closed-loop) Who can help and what is available locally The event included lunch, refreshments, networking opportunities and a range of stalls for diabetes-related products/suppliers and local services. Aim: To examine the feasibility of holding a peer-led conference for people with Type 1 diabetes and determine condition-specific issues of importance to address in future. Methods: A feedback survey was developed and distributed during the conference to ascertain the experience of conference attendees and their preferences for future events. Results: A total of n=58 people attended The One Conference and n=39 feedback forms were completed. 100% of respondents said they would recommend the conference, and had heard about the conference from a wide variety of sources. The feedback received was hugely positive and focused on the variety of sessions offered, reduction in isolation and loneliness and increased self-confidence. Conclusions: Sugar buddies’ approach to actively engaging in peer-support and partnership working with wider services has proven to be beneficial in addressing some of the diabetes-related burden and loneliness associated with the condition. Following the success of this peer-led event Sugar buddies plan to provide more personalised events for people living with diabetes!
BackgroundThe NHS App was launched as a ‘front door’ to digitally enabled health services, offeri... more BackgroundThe NHS App was launched as a ‘front door’ to digitally enabled health services, offering a range of services including appointment booking and ordering prescriptions. The extent of App use and its impacts on digital inclusion is under-explored.AimTo evaluate patterns of App uptake and adoption among different population groups.MethodInterrupted time series analyses explored aggregate monthly App usage from January 2019 - May 2021. Regression model assessed differences in App registration by markers of GP level socio-demographic variables. Qualitative interviews and focus groups involving 83 participants were conducted and analysed thematically.ResultsThere were 8,524,882 App downloads and 4,449,869 registrations. Negative binomial models found 25% less registrations in the most deprived practices (P<0.001) and 44% more registrations in the largest practices (P<0.001). Registration was 36% more in practices with the highest percentage of White patients (P<0.001) a...
Background Internet of Things (IoT) innovations such as wearables and sensors promise improved he... more Background Internet of Things (IoT) innovations such as wearables and sensors promise improved health outcomes and service efficiencies. Yet, most applications remain experimental with little routine use in health and care settings. We sought to examine the multiple interacting influences on IoT implementation, spread and scale-up, including the role of regional innovation ‘ecosystems’ and the impact of the COVID-19 context. Methods Qualitative study involving 20 participants with clinical, entrepreneurial and broader innovation experience in 18 in-depth interviews, focusing primarily on heart monitoring and assistive technology applications. Data analysis was informed by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework. Results Interviewees discussed multiple tensions and trade-offs, including lack of organisational capacity for routine IoT use, limited ability to receive and interpret data, complex procurement and governance processes, and risk of ...
Background The availability, affordability and utilisation of commercially available self-monitor... more Background The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patient-generated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices. Methods Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January–September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiology-affiliated clinicians at the same NHS Trust. Results Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the fi...
Good self-management (SM) of Type 1 diabetes (T1D) has the potential to avoid or delay life-threa... more Good self-management (SM) of Type 1 diabetes (T1D) has the potential to avoid or delay life-threatening and life-limiting complications and improve quality of life, yet is characterised by a demanding, multi-component regimen. The use of insulin pump therapy is growing internationally and has been posited as a way to support better SM of T1D. However, as a complex new technology unique challenges are faced, including complicated requirements for troubleshooting, incorporation and adaptation and carrying an object on the body 24/7. Providing people with SM support to incorporate this technology could improve the lives of people with T1D. However, the dominating biomedical approach to treatment of T1D and incorporation of insulin pump therapy is not enabling appropriate SM. In response, this thesis explores the SM needs of this population and tests a new approach to SM support which is sensitised to a social network approach, underpinned by Social Cognitive Theory. This approach could...
BACKGROUND Type 1 diabetes (T1D) is an autoimmune disease requiring intensive self-management (SM... more BACKGROUND Type 1 diabetes (T1D) is an autoimmune disease requiring intensive self-management (SM). An insulin pump (a new health technology) is designed to better support personal T1D management but at the same time exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social-support and resources from online interventions which offer flexible, innovative and accessible SM. However, questions remain as to which behaviour change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions from both patients and healthcare professionals (HCPs). OBJECTIVE The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist HCPs pertaining to a web-based social network (SN) intervention to support SM and determine what behaviour change characteristics and str...
Background: The availability, affordability and utilisation of commercially available self-monito... more Background: The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patientgenerated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices. Methods: Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January-September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiologyaffiliated clinicians at the same NHS Trust. Results: Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the first Covid-19 lockdown in England, from 8.3% to 16.6% (p < 0.001). In 127/185 (69%) cases self-monitored data were found to: provide or facilitate cardiac diagnoses (34/127); assist management of previously diagnosed cardiac conditions (55/127); be deployed for cardiovascular prevention (16/127); or be recommended for heart rhythm evaluation (10/127). In 58/185 (31%) cases clinicians did not put the self-monitored data to any evident use and in 12/185 (6.5%) cases patient-generated data prompted an unnecessary referral. In interviews and discussions, clinicians expressed mixed views on patient-generated data but foresaw a need to embrace and plan for this information flow, and proactively address challenges with integration into traditional care pathways. Conclusions: This study suggests patient-generated data are being used for clinical decision-making in ad hoc and opportunistic ways. Given shifts towards remote monitoring in clinical care, accelerated by the pandemic, there is a need to consider how best to incorporate patient-generated data in clinical processes, introduce relevant training, pathways and governance frameworks, and manage associated risks.
ObjectivesThis study aimed to evaluate patterns of uptake and adoption of the NHS App. Data metri... more ObjectivesThis study aimed to evaluate patterns of uptake and adoption of the NHS App. Data metrics from the NHS App were used to assess acceptability by looking at total app downloads, registrations, appointment bookings, GP health records viewed, and prescriptions ordered. The impact of the UK COVID-19 lockdown and introduction of the COVID Pass were also explored to assess App usage and uptake.MethodsDescriptive statistics and an interrupted time series analysis were used to look at monthly NHS App metrics at a GP practice level from January 2019-May 2021 in the population of England. Interrupted time series models were used to identify changes in level and trend among App usage and the different functionalities before and after the first COVID-19 lockdown. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting and analysis.ResultsBetween January 2019 and May 2021, there were a total of 8,524,882 NHS App downloads and ...
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recom... more Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOCX 121 kb)
Background: Mixed outcomes and national geographical variations in short and long-term psychologi... more Background: Mixed outcomes and national geographical variations in short and long-term psychological and biomedical benefits of continuous subcutaneous insulin infusion (CSII) have led The University Hospital Southampton (UHS) CSII service (conceived in 2014) to develop a new approach to care; The SPANGLE Model. SPANGLE: Southampton’s patient-orientated approach emphasizes Pump education which is All-inclusive and Non-judgmental. The focus is on Group work which is tailored according to the Life-events and needs patients using this service. Using E-health is also key, running virtual clinics (via email, telephone and texts) to provide a flexible and accessible service. Aim: To assess the impact of insulin pumps on patient outcomes in the context of a relatively new and forward-thinking clinic. Methods: Data were collected from n=90 patients who began CSII therapy at UHS. &gt;6 months ago. Baseline HbA1c, Problem Areas In Diabetes (PAID) and CLARKE hypoglycaemia awareness survey results were compared to 6 months, 1, 2, 3, and 4 years post-pump therapy. Results: Participants had a Mean age of 42.28 ±14 (range 21-77) diagnosis of 21.2 years ±12.40 (1-49 years) and n=55 (61.1%) were Female. A baseline Mean HbA1c of 69mmol/mol±13 (8.5%) reduced significantly to 60mmol/mol±11 (7.6%) at 6 months, (p &lt;0.001), 60mmol/mol±11 (7.6%) at 1 year (p &lt;0.001), 61mmol/mol±13 (7.7%) at 2 years, (p &lt; 0.001), and to 62mmol/mol±11 (7.8%) at 3 years (p &lt; 0.001). HbA1c was still reduced up to 4 years on but results were not statistically significant (lack of statistical power due to low numbers of patients). Baseline PAID scores (32.75± 21) decreased significantly at 6 months (20 ± 17) (p &lt; 0.001) and 1 year (19 ± 16) (p &lt; 0.05). PAID scores continued to be lower at 2 and 3 years than baseline but not significantly (due to low questionnaire response rates). Hypoglycaemia awareness improved from 65% of patients at baseline to 82% (6 months), 88% (1 year) and 92% (2 years) (low survey response rates &gt;2 years). Conclusion: Early evaluations of this patient-orientated clinic are promising due to sustained improvements in glycaemic control, hypoglycaemia awareness and diabetes-related distress. . Future work will focus on whether these results continue to sustain over a longer period and the particular factors that lead to improvements. Uptake of new technologies have increased especially in relation to Flash Glucose Monitoring (available on prescription locally) and Continuous Glucose Monitoring. The service needs to examine how this might impact on patient needs and outcomes.
Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-suppo... more Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-support group ‘Sugar buddies’. It grew from a local need for more information and peer-support for people with Type 1 diabetes (T1D). The event covered; Managing sport and exercise Getting the most from appointments Your local Parkrun The psychological impact of diabetes and managing burnout Technology and beyond (Libre, CGMs, pumps, open/closed-loop) Who can help and what is available locally The event included lunch, refreshments, networking opportunities and a range of stalls for diabetes-related products/suppliers and local services. Aim: To examine the feasibility of holding a peer-led conference for people with Type 1 diabetes and determine condition-specific issues of importance to address in future. Methods: A feedback survey was developed and distributed during the conference to ascertain the experience of conference attendees and their preferences for future events. Results: A total of n=58 people attended The One Conference and n=39 feedback forms were completed. 100% of respondents said they would recommend the conference, and had heard about the conference from a wide variety of sources. The feedback received was hugely positive and focused on the variety of sessions offered, reduction in isolation and loneliness and increased self-confidence. Conclusions: Sugar buddies’ approach to actively engaging in peer-support and partnership working with wider services has proven to be beneficial in addressing some of the diabetes-related burden and loneliness associated with the condition. Following the success of this peer-led event Sugar buddies plan to provide more personalised events for people living with diabetes!
Abstract:
AIMS: Few diabetes interventions come from the perspective of improving self-management... more Abstract: AIMS: Few diabetes interventions come from the perspective of improving self-management through social networks, yet social networks provide a potentially powerful means of mobilising, mediating and accessing support and resources for improved health and well-being. This study aimed to establish what practical and emotional means of support are required upon initiation of insulin pump therapy (IPT) and to determine whether and how the needs of pump users change over time.
METHODS and PARTICIPANTS: A longitudinal design using qualitative semi-structured interviews (n=47), surveys (Problem Areas In Diabetes scale and CLARKE hypoglycaemia score) and routinely collected clinic data (HbA1c) at baseline, 3 and 6 months on from IPT initiation. Participants were people with Type 1 diabetes initiating IPT through the National Health Service (NHS) in the south of England. Interviews explored participant’s expectations and experiences of IPT and the support and resources they required through these time-points.
RESULTS: 16 adults took part in 47 interviews from January 2018 – September 2018. Key themes included: the novelty of the pump creating an increased burden on established self-management practices; the importance of NHS insulin pump clinics, particularly in early stages of incorporation; the necessity of trouble-shooting with peers and; the lack of relevance for particular types of NHS healthcare professionals (such as General Practitioners – GPs) .
CONCLUSIONS: This study has captured the process of adjustment and incorporation of IPT over time and the corresponding network members of pertinence. NHS Insulin pump clinics represented here were praised for their unique, non-judgemental approach. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities, improving the difficulties experienced in this potentially difficult process. The novelty of the new approach to insulin therapy for the individual can create increased illness-burden but particular types of support can improve the difficulties experienced in this process, namely; non-judgemental, flexible and accessible support.
The British Psychological Society (BPS) Division of Health Psychology (DHP) Annual Conference 2018, 2018
Psychological burden and fatigue are well-documented in those living with Type 1 diabetes (PWD). ... more Psychological burden and fatigue are well-documented in those living with Type 1 diabetes (PWD). The introduction of complex new health technologies (e.g. an insulin-pump) can create further disruption. This study aimed to use The Behaviour Change Wheel to explore barriers and facilitators of pump users and healthcare professionals (HCPs) to support the adaptation of a pre-existing online social-support and networking tool (named Genie) to help PWD and an insulin pump self-manage. A qualitative study using Focus Groups was undertaken with insulin pump users (N=19) and specialised diabetes clinicians (physicians, nurses, dieticians) (N=20) to inform adaptation and delivery of Genie. Focus Groups were analysed using Framework analysis. PWD voiced a desire to access flexible holistic support and resources, according to their varying needs at different times. In terms of Genie; PWD expressed wanting to initiate and register their interest for groups with other Type-1-specific PWD. In contrast, HCPs were encouraging of additional ways to facilitate PWD’s access to tailored support, especially outside clinic hours, but raised concerns over the potential for peers to “give bad advice”. HCPs were apprehensive about the capacity and likelihood of the NHS to maintain and fund any additional provision of psychosocial. Genie was deemed as an attractive means to offer personalised social-support for PWD taking on a new health technology by all stakeholders. However, key points for implementing a support tool into practice were; security of funding for ensured maintenance and the ability to actively engage with other PWD to promote psychological wellbeing and prevent burnout.
Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-suppo... more Background: ‘The One Conference’ was the first of its kind by Hampshire-based diabetes peer-support group ‘Sugar buddies’. It grew from a local need for more information and peer-support for people with Type 1 diabetes (T1D). The event covered; Managing sport and exercise Getting the most from appointments Your local Parkrun The psychological impact of diabetes and managing burnout Technology and beyond (Libre, CGMs, pumps, open/closed-loop) Who can help and what is available locally The event included lunch, refreshments, networking opportunities and a range of stalls for diabetes-related products/suppliers and local services. Aim: To examine the feasibility of holding a peer-led conference for people with Type 1 diabetes and determine condition-specific issues of importance to address in future. Methods: A feedback survey was developed and distributed during the conference to ascertain the experience of conference attendees and their preferences for future events. Results: A total of n=58 people attended The One Conference and n=39 feedback forms were completed. 100% of respondents said they would recommend the conference, and had heard about the conference from a wide variety of sources. The feedback received was hugely positive and focused on the variety of sessions offered, reduction in isolation and loneliness and increased self-confidence. Conclusions: Sugar buddies’ approach to actively engaging in peer-support and partnership working with wider services has proven to be beneficial in addressing some of the diabetes-related burden and loneliness associated with the condition. Following the success of this peer-led event Sugar buddies plan to provide more personalised events for people living with diabetes!
Background: Mixed outcomes and national geographical variations in short and long-term psychologi... more Background: Mixed outcomes and national geographical variations in short and long-term psychological and biomedical benefits of continuous subcutaneous insulin infusion (CSII) have led The University Hospital Southampton (UHS) CSII service (conceived in 2014) to develop a new approach to care; The SPANGLE Model. SPANGLE: Southampton’s patient-orientated approach emphasizes Pump education which is All-inclusive and Non-judgmental. The focus is on Group work which is tailored according to the Life-events and needs patients using this service. Using E-health is also key, running virtual clinics (via email, telephone and texts) to provide a flexible and accessible service. Aim: To assess the impact of insulin pumps on patient outcomes in the context of a relatively new and forward-thinking clinic. Methods: Data were collected from n=90 patients who began CSII therapy at UHS. >6 months ago. Baseline HbA1c, Problem Areas In Diabetes (PAID) and CLARKE hypoglycaemia awareness survey results were compared to 6 months, 1, 2, 3, and 4 years post-pump therapy. Results: Participants had a Mean age of 42.28 ±14 (range 21-77) diagnosis of 21.2 years ±12.40 (1-49 years) and n=55 (61.1%) were Female. A baseline Mean HbA1c of 69mmol/mol±13 (8.5%) reduced significantly to 60mmol/mol±11 (7.6%) at 6 months, (p <0.001), 60mmol/mol±11 (7.6%) at 1 year (p <0.001), 61mmol/mol±13 (7.7%) at 2 years, (p < 0.001), and to 62mmol/mol±11 (7.8%) at 3 years (p < 0.001). HbA1c was still reduced up to 4 years on but results were not statistically significant (lack of statistical power due to low numbers of patients). Baseline PAID scores (32.75± 21) decreased significantly at 6 months (20 ± 17) (p < 0.001) and 1 year (19 ± 16) (p < 0.05). PAID scores continued to be lower at 2 and 3 years than baseline but not significantly (due to low questionnaire response rates). Hypoglycaemia awareness improved from 65% of patients at baseline to 82% (6 months), 88% (1 year) and 92% (2 years) (low survey response rates >2 years). Conclusion: Early evaluations of this patient-orientated clinic are promising due to sustained improvements in glycaemic control, hypoglycaemia awareness and diabetes-related distress. . Future work will focus on whether these results continue to sustain over a longer period and the particular factors that lead to improvements. Uptake of new technologies have increased especially in relation to Flash Glucose Monitoring (available on prescription locally) and Continuous Glucose Monitoring. The service needs to examine how this might impact on patient needs and outcomes.
17th European Society for Health and Medical Sociology (ESHMS) Biennial Congress 2018, 2018
Background: There are issues around trust intentions that allow patients to be free of profession... more Background: There are issues around trust intentions that allow patients to be free of professional authority (Scambler and Britten, 2001; Rogers et al., 2009; Mol, 2008). Leveraging support in open systems in one means lay people turn to enable new health practices. Determining ways and means for people to address the challenges they come across in incorporating a new health technology could have an impact on how people are able to self-manage. The online social support and social networking tool (named Genie) visually maps the social network of the user and then enables illumination and navigation to local means of support and resources. However, it is not known how Genie can be implemented with people living with Type 1 diabetes and using an insulin pump. Insulin pumps represent technical progress for people with diabetes to deliver insulin in a way which much more closely resembles a fully-functioning pancreas, yet there are complex issues to consider when an insulin pump is introduced to a person’s life. Objective: In this study we aimed to gather insights of insulin pump users and clinicians to determine what strategies are likely to lead to normalisation of a new technology in their self-management of diabetes and establish how Genie should be adapted to be successfully implemented in clinics. Methods: A qualitative study using Focus Groups were undertaken with insulin pump users (N=19) and clinicians (namely physicians and specialised nurses and dieticians) (N=20). Focus Groups were analysed using the framework approach. Results: Healthcare professionals (HCPs) were encouraging of additional ways to facilitate their patient’s access to tailored support, especially outside of clinic hours. However, concerns were raised about the capacity to maintain and fund any additional provision of care, as well as the integrity of outside services. Concerns were voiced about the envisaged responsibility laden on HCPs in recommending outside (i.e. non-NHS) services or peer-support groups. Some HCPs questioned potential harmful outcomes to their professional role should any negative interactions occur for patients as a result of contact with outside services. However people using an insulin pump were enthusiastic about access to personalised, varied resources, and were hugely keen to have contact with other pump users. It was common for aspirations to adapt Genie to allow registration of particular interests i.e. a local Type 1 diabetes specific running group. Conclusions: Genie enables new forms of trust to emerge as a result of previous tensions between HCPs and patients. As a result the tool was deemed as an attractive means to offer personalised support for people in the process of adaptation to a new health technology, by both clinicians and people using insulin pumps. Key points for implementing a support tool into practice were; security of funding for ensured maintenance, concerns about responsibility and the ability to actively engage with other people living with diabetes.
Adapting and implementing an online social support and networking tool to assist people with diabetes using advanced technologies, 2018
Aim: Understanding patient systems of implementation are central to determining the means by whic... more Aim: Understanding patient systems of implementation are central to determining the means by which to address the challenges faced by a person with a long-term-condition, such as Type 1 diabetes (T1D) when incorporating a new health technology. An example of a new health technology for people with T1D is an insulin pump. This study used The Behaviour Change Wheel to think about implementation from an expert-by-experience perspective to explore how insulin pump users adopt an online social-support and networking tool (GENIE) to support self-management. Method: A qualitative study using Focus Groups was undertaken with insulin pump users (N=20) and diabetes-specialist clinicians (N=20). Focus Groups were analysed using framework analysis. Results: Pump users were enthusiastic about access to personalised, varied resources. They were also keen for GENIE to allow registration of particular interests i.e. a local diabetes-specific running group. Pump users wanted to engage with others with shared knowledge in a similar position. Clinicians were encouraging of access to tailored support, especially outside clinic hours, but raised concerns over the potential for T1D peers to “give bad advice”. Concerns were voiced about the envisaged responsibility laden on clinicians recommending non-NHS services or groups. HCPs were also apprehensive about the capacity and likelihood of the NHS to prioritise, maintain and fund psychosocial support in addition to routine care. Conclusion: GENIE was deemed as an attractive means to offer personalised self-management support for people with T1D taking on a new health technology, by all stakeholders. However, while GENIE compliments NHS provision of care, key points for implementing a support tool into practice were; security of funding for ensured maintenance and delivery of the tool and the ability for pump users to actively engage with other people living with diabetes.
The British Psychological Society (BPS) Division of Health Psychology (DHP) Annual Conference 2018, 2018
Psychological burden and fatigue are well-documented in those living with Type 1 diabetes (PWD). ... more Psychological burden and fatigue are well-documented in those living with Type 1 diabetes (PWD). The introduction of complex new health technologies (e.g. an insulin-pump) can create further disruption. This study aimed to use The Behaviour Change Wheel to explore barriers and facilitators of pump users and healthcare professionals (HCPs) to support the adaptation of a pre-existing online social-support and networking tool (named Genie) to help PWD and an insulin pump self-manage. A qualitative study using Focus Groups was undertaken with insulin pump users (N=19) and specialised diabetes clinicians (physicians, nurses, dieticians) (N=20) to inform adaptation and delivery of Genie. Focus Groups were analysed using Framework analysis. PWD voiced a desire to access flexible holistic support and resources, according to their varying needs at different times. In terms of Genie; PWD expressed wanting to initiate and register their interest for groups with other Type-1-specific PWD. In contrast, HCPs were encouraging of additional ways to facilitate PWD’s access to tailored support, especially outside clinic hours, but raised concerns over the potential for peers to “give bad advice”. HCPs were apprehensive about the capacity and likelihood of the NHS to maintain and fund any additional provision of psychosocial support. Genie was deemed as an attractive means to offer personalised social-support for PWD taking on a new health technology by all stakeholders. However, key points for implementing a support tool into practice were; security of funding for ensured maintenance and the ability to actively engage with other PWD to promote psychological wellbeing and prevent burnout.
Background: Insulin pump therapy, or Continuous Subcutaneous Insulin Infusion (CSII), is a techno... more Background: Insulin pump therapy, or Continuous Subcutaneous Insulin Infusion (CSII), is a technological advancement that can help people manage Type 1 diabetes (T1D) better; both in terms of benefits to the patient and resulting impact on health service resources. However, new ways of managing diabetes and implementing new health technologies bring new complexities. Understanding the factors which enable people with T1D to incorporate CSII could provide an exemplar for patients to incorporate new technologies; providing much needed flexibility and choice in how people manage their long-term condition(s).
Methods: A systematic search of seven databases was conducted to identify studies published from 2008 onwards reporting lived experiences of CSII. The methods of critical interpretative synthesis were used to identify domains from the literature that are key to successfully incorporating CSII.
Results: A total of 4,998 titles were identified, 274 abstracts and 39 papers were viewed. Finally, 20 papers were included. From the analysis, three themes emerged of relevance to the introduction and use of the pump. Firstly, there are Tensions between expectations and experiences in adoption and early adaptation of the pump; secondly, a need to Negotiate responsibility and access support with health care professionals (HCPs) and wider networks; and thirdly, a process of Reflexivity, active experimentation and feedback.
Conclusions: This review suggests a period of adjustment that emerges over time. A process of navigation and response to a range of contingent bodily sensations and technological demands occurs that were unexpected at the outset. For improved integration: early conversations with HCPs about the likely period of disruption; negotiations about responsibility for management tasks; and the opportunity for new pump users to build confidence about using the pump, need to occur. Examining the support that pump users have access to, and enabling them to tap into further means of support and resources, could improve pump incorporation.
Background: Extensive research has been conducted focusing on children or adults living with Type... more Background: Extensive research has been conducted focusing on children or adults living with Type 1 diabetes, but those between 16 and 25 are under-researched. However, there is evidence that patients’ cognitions (thoughts about illness) and emotional reactions combine to form what can be described as ‘illness perceptions’ that drive behaviour. Aims: To explore how illness perceptions, clinical and significant life events influence glycaemic control in the emerging adults living with Type 1 diabetes. Methods: This was an observational, cross-sectional approach (N = 70) using a self-report questionnaire pack: Brief Illness Perceptions Questionnaire, Diabetes Psychological Adjustment Scale, Body Shape Questionnaire 8B, Patient Health Questionnaire 8, Generalised Anxiety Disorder Assessment 7, and an additional questionnaire looking at clinical and significant life events. Results: A hierarchical logistic regression model found that illness perceptions of personal control and understanding were the best fit for predicting glycaemic control (multiple R = 75.3) and account for 49.4% of the difference in the groups (p = 0.002). BSQ-8B scores demonstrated that a more negative perception of one’s own body shape is related to higher HbA1c levels in women. The PHQ-8 also demonstrated that higher levels of depression are related to higher HbA1c levels. Discussion: An interplay of understanding and personal control could have a significant effect on glycaemic control along with negative body image (in women) and higher levels of depression. Where conventional methods of glycaemic control are less effective in this group, the findings suggest that targeted and specific psychological support could improve glycaemic control.
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Papers by Claire Reidy
AIMS: Few diabetes interventions come from the perspective of improving self-management through social networks, yet social networks provide a potentially powerful means of mobilising, mediating and accessing support and resources for improved health and well-being. This study aimed to establish what practical and emotional means of support are required upon initiation of insulin pump therapy (IPT) and to determine whether and how the needs of pump users change over time.
METHODS and PARTICIPANTS:
A longitudinal design using qualitative semi-structured interviews (n=47), surveys (Problem Areas In Diabetes scale and CLARKE hypoglycaemia score) and routinely collected clinic data (HbA1c) at baseline, 3 and 6 months on from IPT initiation. Participants were people with Type 1 diabetes initiating IPT through the National Health Service (NHS) in the south of England. Interviews explored participant’s expectations and experiences of IPT and the support and resources they required through these time-points.
RESULTS: 16 adults took part in 47 interviews from January 2018 – September 2018. Key themes included: the novelty of the pump creating an increased burden on established self-management practices; the importance of NHS insulin pump clinics, particularly in early stages of incorporation; the necessity of trouble-shooting with peers and; the lack of relevance for particular types of NHS healthcare professionals (such as General Practitioners – GPs) .
CONCLUSIONS: This study has captured the process of adjustment and incorporation of IPT over time and the corresponding network members of pertinence. NHS Insulin pump clinics represented here were praised for their unique, non-judgemental approach. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities, improving the difficulties experienced in this potentially difficult process. The novelty of the new approach to insulin therapy for the individual can create increased illness-burden but particular types of support can improve the difficulties experienced in this process, namely; non-judgemental, flexible and accessible support.
Objective: In this study we aimed to gather insights of insulin pump users and clinicians to determine what strategies are likely to lead to normalisation of a new technology in their self-management of diabetes and establish how Genie should be adapted to be successfully implemented in clinics.
Methods: A qualitative study using Focus Groups were undertaken with insulin pump users (N=19) and clinicians (namely physicians and specialised nurses and dieticians) (N=20). Focus Groups were analysed using the framework approach.
Results: Healthcare professionals (HCPs) were encouraging of additional ways to facilitate their patient’s access to tailored support, especially outside of clinic hours. However, concerns were raised about the capacity to maintain and fund any additional provision of care, as well as the integrity of outside services. Concerns were voiced about the envisaged responsibility laden on HCPs in recommending outside (i.e. non-NHS) services or peer-support groups. Some HCPs questioned potential harmful outcomes to their professional role should any negative interactions occur for patients as a result of contact with outside services. However people using an insulin pump were enthusiastic about access to personalised, varied resources, and were hugely keen to have contact with other pump users. It was common for aspirations to adapt Genie to allow registration of particular interests i.e. a local Type 1 diabetes specific running group.
Conclusions: Genie enables new forms of trust to emerge as a result of previous tensions between HCPs and patients. As a result the tool was deemed as an attractive means to offer personalised support for people in the process of adaptation to a new health technology, by both clinicians and people using insulin pumps. Key points for implementing a support tool into practice were; security of funding for ensured maintenance, concerns about responsibility and the ability to actively engage with other people living with diabetes.
Method: A qualitative study using Focus Groups was undertaken with insulin pump users (N=20) and diabetes-specialist clinicians (N=20). Focus Groups were analysed using framework analysis.
Results: Pump users were enthusiastic about access to personalised, varied resources. They were also keen for GENIE to allow registration of particular interests i.e. a local diabetes-specific running group. Pump users wanted to engage with others with shared knowledge in a similar position. Clinicians were encouraging of access to tailored support, especially outside clinic hours, but raised concerns over the potential for T1D peers to “give bad advice”. Concerns were voiced about the envisaged responsibility laden on clinicians recommending non-NHS services or groups. HCPs were also apprehensive about the capacity and likelihood of the NHS to prioritise, maintain and fund psychosocial support in addition to routine care.
Conclusion: GENIE was deemed as an attractive means to offer personalised self-management support for people with T1D taking on a new health technology, by all stakeholders. However, while GENIE compliments NHS provision of care, key points for implementing a support tool into practice were; security of funding for ensured maintenance and delivery of the tool and the ability for pump users to actively engage with other people living with diabetes.
A qualitative study using Focus Groups was undertaken with insulin pump users (N=19) and specialised diabetes clinicians (physicians, nurses, dieticians) (N=20) to inform adaptation and delivery of Genie. Focus Groups were analysed using Framework analysis.
PWD voiced a desire to access flexible holistic support and resources, according to their varying needs at different times. In terms of Genie; PWD expressed wanting to initiate and register their interest for groups with other Type-1-specific PWD. In contrast, HCPs were encouraging of additional ways to facilitate PWD’s access to tailored support, especially outside clinic hours, but raised concerns over the potential for peers to “give bad advice”. HCPs were apprehensive about the capacity and likelihood of the NHS to maintain and fund any additional provision of psychosocial support.
Genie was deemed as an attractive means to offer personalised social-support for PWD taking on a new health technology by all stakeholders. However, key points for implementing a support tool into practice were; security of funding for ensured maintenance and the ability to actively engage with other PWD to promote psychological wellbeing and prevent burnout.
Methods: A systematic search of seven databases was conducted to identify studies published from 2008 onwards reporting lived experiences of CSII. The methods of critical interpretative synthesis were used to identify domains from the literature that are key to successfully incorporating CSII.
Results: A total of 4,998 titles were identified, 274 abstracts and 39 papers were viewed. Finally, 20 papers were included. From the analysis, three themes emerged of relevance to the introduction and use of the pump. Firstly, there are Tensions between expectations and experiences in adoption and early adaptation of the pump; secondly, a need to Negotiate responsibility and access support with health care professionals (HCPs) and wider networks; and thirdly, a process of Reflexivity, active experimentation and feedback.
Conclusions: This review suggests a period of adjustment that emerges over time. A process of navigation and response to a range of contingent bodily sensations and technological demands occurs that were unexpected at the outset. For improved integration: early conversations with HCPs about the likely period of disruption; negotiations about responsibility for management tasks; and the opportunity for new pump users to build confidence about using the pump, need to occur. Examining the support that pump users have access to, and enabling them to tap into further means of support and resources, could improve pump incorporation.