The DAFNE plus programme for sustained type 1 diabetes self management: Intervention development using the Behaviour Change Wheel
Open accessAbstract
AIMS: Self-management programmes for type 1 diabetes, such as the UK's Dose Adjustment for Normal Eating (DAFNE), improve short-term clinical outcomes but difficulties maintaining behavioural changes attenuate long-term impact. This study used the Behaviour Change Wheel (BCW) framework to revise the DAFNE intervention to support sustained behaviour change. METHODS: A four-step method was based on the BCW intervention development approach: (1) Identifying self-management behaviours and barriers/enablers to maintain them via stakeholder consultation and evidence synthesis, and mapping barriers/enablers to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. (2) Specifying behaviour change techniques (BCTs) in the existing DAFNE intervention using the Behaviour Change Techniques Taxonomy (BCTTv1). (3) Identifying additional BCTs to target the barriers/enablers using the BCW and BCTTv1. (4) Parallel stakeholder consultation to generate recommendations for intervention revision. Revised materials were co-designed by stakeholders (diabetologists, psychologists, specialist nurses and dieticians). RESULTS: In all, 34 barriers and 5 enablers to sustaining self-management post-DAFNE were identified. The existing DAFNE intervention contained 24 BCTs, which partially addressed the enablers. In all, 27 BCTs were added, including 'Habit formation', 'Credible source' and 'Conserving mental resources'. In total, 15 stakeholder-agreed recommendations for content and delivery were incorporated into the final DAFNEplus intervention, comprising three co-designed components: (1) face-to-face group learning course, (2) individual structured follow-up sessions and (3) technological support, including blood glucose data management. CONCLUSIONS: This method provided a systematic approach to specifying and revising a behaviour change intervention incorporating stakeholder input. The revised DAFNEplus intervention aims to support the maintenance of behavioural changes by targeting barriers and enablers to sustaining self-management behaviours.
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Teaching people with diabetes to balance insulin use and carbohydrate intake and physical activity are necessary, but these strategies are not always sufficient for prevention.
“Teaching people with diabetes to balance insulin use and carbohydrate intake and physical activity are necessary, but these strategies are not always sufficient for prevention (77,(103)(104)(105).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [103]
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6. Glycemic Targets: <i>Standards of Medical Care in Diabetes—2022</i>
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- Authors
- Stanton‐Fay, S. H., Hamilton, K., Chadwick, P. M., Lorencatto, F., Gianfrancesco, C., de Zoysa, N., Coates, E., Cooke, D., McBain, H., Heller, S. R., Michie, S., & the DAFNEplus study group
- Affiliations
- Clinical, Health and Educational Psychology/Centre for Behaviour Change University College London London United Kingdom of Great Britain and Northern Ireland
- University College London (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Diabetes Centre King’s College Hospital London United Kingdom of Great Britain and Northern Ireland
- University of Sheffield (GB)
- University of Surrey (GB)
- City, University of London (GB)
- ORCID
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2021-03-10
- Volume
- 38
- Issue
- 5
- Pages
- e14548-e14548
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W3133222905
- Cited by
- 33
- References
- 38
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 10 · 2023: 3 · 2022: 5 · 2021: 5
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetic Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Funders
- Programme Grants for Applied Research (RP‐PG‐0514‐20013)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, diabetes self-management, Behaviour Change Wheel, COM-B model, behaviour change techniques, intervention development, maintenance of behaviour change, barriers and facilitators, co-design, stakeholder consultation, habit formation
- MeSH terms
- Psychosocial Support Systems, Self-Management, Behavior Therapy, Communication Barriers, Delivery of Health Care, Diabetes Mellitus, Type 1, Humans, Motivation, Patient Education as Topic, Patient Participation, Risk Reduction Behavior
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