Click on the projects below to learn more
In collaboration with Dr Kylie Mosely (Australian Catholic University, NSW).
Regular physical activity (PA) is one of the cornerstones of diabetes management. Research has shown that engaging in regular PA reduces blood glucose levels, thus reducing the risk of diabetes-related complications. Whilst the majority of type 2 diabetes (T2DM) is managed in primary care settings, the recent Diabetes MILES – Australia study indicated that 50% of adults with type 2 diabetes never or only occasionally engage in the recommended amount of PA; and less than half of those advised about PA by their primary care health professional acted upon the advice. As such, the majority of people with type 2 diabetes are not sufficiently active and not acting on the PA advice they receive from health professionals. Using a comprehensive theory of health behaviour change, this project aims to (1) understand the factors affecting the promotion of increased levels of PA among adults with T2DM by primary care health professionals, and (2) determine whether the low levels of PA among Australian adults with type 2 diabetes are due to lack of knowledge about the importance of PA, or lack of support, motivation, or behavioural skills. The project involves a mixed method two-phase process. The two phases will run sequentially. The first phase involves focus groups and interviews with adults with T2DM and primary care practitioners. The second phase involves a large-scale survey of adults with T2DM and primary care practitioners. The findings of the study will assist in designing interventions to promote PA in adults with type 2 diabetes in primary care.
Approximately a quarter of people with type 2 diabetes (T2D) are unwilling to begin insulin therapy despite it being almost inevitable for the effective management of this progressive condition. This negative appraisal of insulin is known as ‘Psychological Insulin Resistance’. Health professionals may also hold negative appraisals of insulin therapy, which can influence how insulin is regarded by people with T2D. Led by PhD candidate Elizabeth Holmes-Truscott, this research aims to quantify the level, and the determinants, of psychological insulin resistance in a national Australian context as well as investigate interventions to improve receptiveness to insulin among adults with T2D. This body of work will highlight barriers to insulin initiation for Australian adults with T2D as well as understanding what facilitates change in insulin appraisals.
Regular eye examinations are essential in detecting diabetic retinopathy (DR), one of the leading causes of vision loss for people living with diabetes. Maintenance of optimal blood glucose and blood pressure, as well as early detection and treatment of DR via eye screens are key factors in the successful management of the condition. However, as both type 2 diabetes and DR are often asymptomatic in the early stages, people with newly diagnosed T2DM are particularly vulnerable to DR. It is estimated that only half of Australians with diabetes have regular eye exams and one third have never been checked. The Diabetes and Eye Health project aims to raise awareness of the importance of managing the key risk factors for DR, whilst increasing intentions to engage in regular eye examinations. The intended outcome of this project will be the development of evidence-based communication interventions that will increase the intent of Victorian adults diagnosed with type 2 diabetes to seek eye exams and minimise their risk of developing DR.
In collaboration with Dr Kylie Mosely (Australian Catholic University, NSW).
Although healthcare professionals and others who do not have diabetes do not always recognise the negative social experience that can result from having diabetes, those with the condition report many concerns, including social embarrassment, feelings of failure and guilt. Other negative experiences that people with diabetes perceive or experience as a result of their condition may include workplace discrimination, negative public attitudes toward needle use and a negative obesity bias across many different social settings and life domains. The effect of this has the potential to impact negatively on the psychological health and physical health of those living with diabetes. The ACBRD has undertaken interviews with adults with type 1 or type 2 diabetes to explore the social experience of living with these conditions. The aims of the interviews are to explore the public perceptions of, and behaviour towards, people living with diabetes and how the consequences of these perceptions and behaviours impact on the lives of those with this condition.
Successful management of diabetes requires attention to the behavioural, psychological and social aspects of the condition. The Diabetes MILES Study an international collaborative that constitutes national surveys of people with diabetes in various countries, with a focus on the psychosocial and behavioural aspects of the condition. Diabetes MILES – Australia was the first to be undertaken and completed in mid 2011. Diabetes MILES – The Netherlands has since also been completed, with preparations underway for Diabetes MILES - Flanders in Belgium. The information, collected through these surveys, has the potential to inform future health policy and service provision so that people with diabetes receive optimal care. You can learn more about the Diabetes MILES Study by visiting www.diabetesMILES.org. You can also read the Diabetes MILES – Australia 2011 Survey Report here.
In collaboration with Prof Peter Colman and Jo Bowden (Royal Melbourne Hospital), Assoc/Prof Alicia Jenkins and Assoc/Prof David O'Neal (St Vincent's Hospital), Dr Neale Cohen (Baker IDI Heart and Diabetes Institute)
The aim of this study is 1) to conduct a 'snapshot' audit to examine the prevalence of psychological distress, depression, fear of hypoglycaemia and impaired awareness of hypoglycaemia (IAH) among adults with T1DM attending three metropolitan tertiary centres and among adults with T1DM or T2DM in a regional diabetes clinic, and 2) to explore relationships between psychological, clinical and demographic variables.
Despite their clear implications for diabetes management and outcomes (acute and long-term), psychological factors (including diabetes-related distress, depression, fear of hypoglycaemia and IAH) are not routinely monitored in clinical practice. Psychological support is not reimbursable via tertiary referrals and we need local evidence in order to build a strong case for greater psychological support for adults with T1DM or T2DM.
The audit has being conducted across three tertiary clinics (Royal Melbourne Hospital - RMH, Baker IDI, St Vincent's Hospital - SVH) and is still ongoing in one regional diabetes clinic in Werribee. Over an 8-12 week period, all consecutive adult clinic attendees with T1DM or T2DM (only in Werribee clinic) were invited to complete a set of questionnaires and gave permission to access clinical data. The outcomes of this audit will contribute improving psychological outcomes for adults with diabetes as well as for raising awareness of psychological issues in T1DM and T2DM amongst local clinicians. The findings will lead to the design and implementation of easy-to-use monitoring tools for routine clinical practice. Expertise will be built up to train health care providers in identifying psychological distress/disorders and in communicating these outcomes to people with diabetes, offering accurate treatment (by the diabetes team or by referring the patient with diabetes to a specialist).
In collaboration with Prof Christopher Gilfillan (Eastern Health).
The Integrated Diabetes Education and Assessment Service (IDEAS) is a community health-based clinic for people with type 2 diabetes. The IDEAS clinics offer collaborative, multidisciplinary care for people with type 2 diabetes in a community setting. This differs from the traditional acute clinics which are based on a typical medical model, where various services (e.g. diabetes education, podiatry) cannot usually be accessed at the same time and same place. In contrast, the IDEAS clinics offer half-day appointments, giving people the opportunity for tailored, multidisciplinary care at the one location during the one appointment. While evidence from systematic reviews indicates that integrated care for chronic conditions has positive effects on functional health status and quality of care, the impact of this approach on other patient reported outcomes, particularly psychosocial outcomes, is unclear. Many other evaluation studies of collaborative care models for chronic conditions such as diabetes have focussed on biomedical or economic outcomes alone. The Centre, in collaboration with Eastern Health is conducting a randomised controlled study to evaluate the IDEAS model of diabetes, particularly with regard to the impact of diabetes care received at the IDEAS clinics on patient-reported psychosocial outcomes. This evaluation study is funded primarily by Whitehorse Community Health, who received a Building The Evidence grant from the Department of Health and Ageing to undertake this evaluation study.
In collaboration with Ann Morris (St John of God Warrnambool Hospital)
International guidelines for diabetes care recommend routine monitoring of wellbeing of people with diabetes, however this rarely occurs in clinical settings. The Australian Centre for Behavioural Research in Diabetes exploring the feasibility and acceptability of monitoring diabetes-related distress as part of routine care in a regional diabetes clinic. All adults with type 1, type 2, or gestational diabetes complete the 20-item Problem Areas In Diabetes (PAID) scale as part of routine care at each visit to the diabetes clinic. Information from the questionnaire is used by the clinician to inform person-centred, psychologically-sensitive care and appropriate referral to mental health services. De-identified data are analysed by the Centre to assess the level of diabetes-related distress in this group, its relationship to HbA1c, and to conduct preliminary validation of the PAID scale in an unselected Australian sample.
Negative or unhelpful words and phrases used with or about people with diabetes, can take place in the social media and community space, within individual’s families and peer groups, and perhaps most significantly in healthcare consultations. The Australian Centre for Behavioural Research in Diabetes is undertaking a series of 1.5hr focus groups with Victorian adults with type 1 or type 2 diabetes. The aim is to explore the current language used in talking about and with people with diabetes; understand how certain words/phrases impact upon the thoughts, feelings and behaviours of people with diabetes; and gather information, and provoke discussion, about whether a preferred ‘diabetes talk’ or language is necessary and what this language may include. Focus groups are ongoing.
... for me, emotional
and psychological health is at
least as important as physically
doing what I need to do........
- Person living with diabetes