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Health services research
Protocol
Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model
  1. Chrysanthi Papoutsi1,
  2. Dougal Hargreaves2,
  3. Grainne Colligan3,
  4. Ann Hagell4,
  5. Anita Patel3,
  6. Desirée Campbell-Richards5,
  7. Russell M Viner2,
  8. Shanti Vijayaraghavan5,
  9. Martin Marshall6,
  10. Trisha Greenhalgh1,
  11. Sarah Finer3,5
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 UCL Great Ormond St. Institute of Child Health, University College London, London, UK
  3. 3 Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  4. 4 Association for Young People’s Health, London, UK
  5. 5 Barts Health NHS Trust, London, UK
  6. 6 Department of Primary Care and Population Health, University College London, London, UK
  1. Correspondence to Dr. Sarah Finer; s.finer{at}qmul.ac.uk

Abstract

Introduction Young adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional one-to-one consultations, by engaging young people through life stage-, context- and culturally-sensitive approaches. In this study, we will co-design and evaluate a group-based care model for young adults with diabetes and complex health and social needs in socioeconomically deprived areas.

Methods and analysis This participatory study will include three phases. In phase 1, we will carry out a realist review to synthesise the literature on group-based care for young adults with diabetes. This theory-driven understanding will provide the basis for phase 2, where we will draw on experience-based co-design methodologies to develop a new, group-based care model for young adults (aged <25 years, under the care of adult diabetes services). In phase 3, we will use a researcher-in-residence approach to implement and evaluate the co-designed group clinic model and compare with traditional care. We will employ qualitative (observations in clinics, patient and staff interviews and document analysis) and quantitative methods (eg, biological markers, patient enablement instrument and diabetes distress scale), including a cost analysis.

Ethics and dissemination National Health Service ethics approval has been granted (reference 17/NI/0019). The project will directly inform service redesign to better meet the needs of young adults with diabetes in socioeconomically deprived areas and may guide a possible cluster-randomised trial, powered to clinical and cost-effectiveness outcomes. Findings from this study may be transferable to other long-term conditions and/or age groups. Project outputs will include briefing statements, summaries and academic papers, tailored for different audiences, including people living with diabetes, clinicians, policy makers and strategic decision makers.

Registration details PROSPERO (CRD42017058726).

  • group clinics
  • diabetes
  • young adults
  • realist review
  • evaluation
  • co-design.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-017363

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    Footnotes

    • Contributors SF and DH conceptualised the study with input from MM, TG, AH, AP, DC-R, RMV, SV and GC. CP and SF wrote the first draft of this manuscript with significant input from DH, TG, MM, AH, AP, DC-R, RMV, SV and GC. All authors have read and approved the final manuscript.

    • Funding This work is supported by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (ref. no. 15/25/20).

    • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Research Health Services and Deliver Research programme, National Institute for Health Research, National Health Service or the Department of Health.

    • Competing interests None declared.

    • Patient consent The submitted paper is a study protocol.

    • Ethics approval Office for Research Ethics Committees Northern Ireland (reference 17/NI/0019).

    • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

    • Data sharing statement Given this is a study protocol, no data are available to be shared yet. The authors will make appropriate provisions for data sharing and will include a statement in the paper describing the results of this study instead.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.