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Articles by K. Ismail
Total Records ( 4 ) for K. Ismail
  K. Ridge , J. Treasure , A. Forbes , S. Thomas and K. Ismail
  Aims To elicit the barriers and motivators to better diabetes self care in patients with Type 1 diabetes. Methods  We obtained a purposive sample of 47 patients with Type 1 diabetes and persistent suboptimal glycaemic control from a randomized controlled trial of nurse-delivered psychological interventions. Each participant’s second session of motivational interviewing was analysed using content analysis. Results Four major themes emerged: emotions of living with Type 1 diabetes, perceived barriers to diabetes management, motivators for change and methods of coping. Increased assistance and support from family and healthcare teams, the prospect of improved emotional and physical well-being and feelings of success were described as factors that might motivate participants to practice more effective self care. Conclusions An enhanced awareness of the range of psychological concepts in diabetes may enable a better therapeutic relationship between clinicians and patients.
  T. R. J. Nicholson , J.-P. Taylor , C. Gosden , P. Trigwell and K. Ismail
  Aims  To assess the availability and types of psychological services for people with diabetes in the UK, compliance with national guidelines and skills of the diabetes team in, and attitudes towards, psychological aspects of diabetes management.

Methods  Postal questionnaires to team leads (doctor and nurse) of all UK diabetes centres (n = 464) followed by semi-structured telephone interviews of expert providers of psychological services identified by team leads.

Results  Two hundred and sixty-seven centres (58%) returned postal questionnaires; 66 (25%) identified a named expert provider of psychological services, of whom 53 (80%) were interviewed by telephone. Less than one-third (n = 84) of responding centres had access to specialist psychological services and availability varied across the four UK nations (= 0.02). Over two-thirds (n = 182) of centres had not implemented the majority of national guidelines and only 2.6% met all guidelines. Psychological input into teams was associated with improved training in psychological issues for team members (P < 0.001), perception of better skills in managing more complex psychological issues (P ≤ 0.01) and increased likelihood of having psychological care pathways (P ≤ 0.05). Most (81%) expert providers interviewed by telephone were under-resourced to meet the psychological needs of their population.

Conclusions  Expert psychological support is not available to the majority of diabetes centres and significant geographical variation indicates inequity of service provision. Only a minority of centres meet national guidelines. Skills and services within diabetes teams vary widely and are positively influenced by the presence of expert providers of psychological care. Lack of resources are a barrier to service provision.

  A. Patel , E. Maissi , H.-C. Chang , I. Rodrigues , M. Smith , S. Thomas , T. Chalder , U. Schmidt , J. Treasure and K. Ismail
  Aims  To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes.

Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year.

Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings.

Conclusions  Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  K. Ridge , S. Thomas , P. Jackson , S. Pender , S. Heller , J. Treasure and K. Ismail
 

Aims

To describe the development of an intervention for parents and carers of young people with Type 1 diabetes and assess the feasibility, acceptability and emerging clinical themes.

Methods

Participants were carers of young persons aged 10-18 years with a diagnosis of Type 1 diabetes of more than 12 months' duration in two inner-city South London hospitals. Carers were invited to attend six sessions of a group workshop where they received emotional support, diabetes education and were taught motivational interviewing techniques to support their child.

Results

Out of 106 eligible participants, carers of 31 young people with Type 1 diabetes were recruited, 17 of whom ‘completed’ the intervention (attending four or more sessions). Participants discussed a variety of themes in session, including the increasing difficulty of diabetes management as children grow older, parenting techniques for managing diabetes in the home and the emotional challenges of having a child with a chronic illness.

Conclusions

Engaging parents in a carer intervention for Type 1 diabetes was a challenge, but parents who participated appeared to value the programme. Future interventions for carers need to take account of carers' wishes and expectations in order to maximize user uptake.

 
 
 
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