The Diabetes Remission Clinical Trial (DiRECT) Study takes a new approach to improve the chances of a successful rollout. Twenty healthcare professionals were interviewed after delivering the DiRECT to find the major barriers to initial engagement of the study.
The views of healthcare professionals delivering DiRECT
A new study from the DiRECT team, published in Diabetic Medicine, has delved into the experiences of healthcare professionals (HCPs) who delivered the trial’s weight management programme. The researchers hope that insights into the challenges and facilitators of implementing DiRECT in primary care can be used to improve the chances of a successful, wider rollout.
Ten GPs completed a questionnaire, and ten practice nurses or dietitians were interviewed approximately 12 months after they started delivering DiRECT. HCPs’ concerns about the potential harms of withdrawing antidiabetic and antihypertensive medication at the beginning of the trial, and about complications of rapid weight loss, were found to be major barriers to initial engagement and adoption of DiRECT. The DiRECT team found that these concerns were best alleviated through thorough discussions with HCPs and by providing clear and robust research evidence on the intervention.
The HCPs trust in the research team and perceived credibility of the study were also found to be important in the adoption of DiRECT. Taking lessons from the roll-out of the Diabetes Prevention Programme (DPP) in England, the DiRECT team noted that raising awareness of the programme was vital to the uptake of the intervention. They suggest a national campaign by the NHS at the right level and time might facilitate DiRECT ‘brand recognition’ and bolster HCP engagement.
Ongoing training and support infrastructure were also found to help in DiRECT’s delivery. The study found that practice nurses, who tended to have less experience with the delivery of dietary interventions compared to dietitians, found the training and mentoring programme provided as part of the trial particularly valuable. Considering the type of HCP to deliver DiRECT in future delivery may be important in determining the resources needed.
HCPs strongly valued the support infrastructure, and researchers suggest that a wider roll-out of the remission programme might require a scale-up of professional support networks and mechanisms for HCPs to share information and learnings.
