Type 2 Diabetes - framework for prevention, early detection and intervention: evaluation

Appendix 1: Research questions identified through a series of workshops with Evaluation Advisory Group members

The following research questions were identified by Evaluation Advisory Group members and are underpinned by the desired short-term outcomes of the Framework.

1. Has the prevention framework been effectively implemented in early adopter areas?

• Effective implementation involves establishing effective pre-diabetes, type 2 diabetes and GDM identification mechanisms, improved access to specialist care for women with GDM and to weight management programmes for those at risk of, or with, type 2 diabetes. A detailed description of indicators of successful implementation is given in the evaluation framework attached.
• Do weight management services meet the minimum standards for weight management?
• Are services effectively integrated across primary and secondary care to provide comprehensive care pathways? Does information flow smoothly between services to enable effective decision-making and service improvement?

2. What are the barriers and enablers to delivery from the perspective of patients and health professionals involved in delivering the care pathways (namely, GPs or practice nurses, dietitians, weight management providers, type 2 diabetes consultants, midwives and consultant obstetricians)?

• What, if any, solutions have been found to service implementation barriers?
• What motivates/deters patients from joining weight management services when referred? What are reasons for drop-out? Do patients feel that the weight management programmes cater for their individual needs? Do patients consider that the programmes worked for them? What support mechanisms are offered at maintenance phase?

3. How, if at all, does the implementation vary between early adopter areas?

Although health boards are expected to meet the minimum standards for weight management services, the prevention framework is not prescriptive of the type, length and content of interventions, allowing for a certain degree of variation in implementation between areas.

• How, if at all, do recruitment, staffing and services offered vary between sites?
• What contextual factors enable or hinder the successful implementation of the framework? What, if any, solutions were found to contextual barriers?
• What criteria do services use to allocate patients to particular interventions?

4. What, if any, are the unintended consequences of the prevention framework for patients and/or service delivery?

• Unintended consequences for patients would include psychosocial (such as stigmatisation, development of body dissatisfaction, lowered self-esteem, anxiety) or economic harm (need to invest more of disposable income into commercial weight management programmes)
• Unintended consequences for services would be increased focus of weight management services on patients with or at risk of type 2 diabetes to the detriment of other patient groups

5. Have effective mechanisms for identifying high risk populations been identified?

Risk of type 2 diabetes increases with age, is higher among particular ethnic groups, those who are overweight, have high blood pressure. And women with a history of gestational diabetes. In Scotland, incidence of type 2 diabetes has stabilised in the past few years, but has increased among young men and both men and women from most deprived areas.

6. How do services ensure effective engagement and support for people who are hard to reach?

Research suggests that some of the at risk groups are less likely to access services, accept referrals to weigh management and complete programmes.

7. What changes to the framework would improve national roll-out?