Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Need Assessment Phase
2.3. Creative Design and Development
2.4. Evaluation
3. Results
3.1. Need Assessment
3.2. Creative Design Phase and Development
3.3. Evaluation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Dimensions | Themes | Sub-Themes | Illustrative Quotes |
---|---|---|---|
Patient education | Content | Explanation of the targeted diseases, their complications and how to take action | PA1: “… that it explains very clearly what diabetes is. What its causes and consequences are.” PA2: “For every single test that they do, they explain why they do them and what the category of results would possibly mean... and that I should take further action.” PA6: “… information like “watch out for this and that and that”, I think that’s useful.” PA7: “My diet and my lifestyle, I think I’m in good control of that, but I can imagine that if that weren’t the case, I would need guidance.” PA9: “For diabetes, things like what foods to avoid, for example, things like that… Or foods to favour, maybe times to eat, times not to eat.” PA10: “If you have to change that at the dietary level, so certain types of food or certain packaging things to look out for. Certain food rations. I don’t know all that… So one folder on everything that’s physical activity, then another on everything related to food.” PA13: “I expect there to be a predetermined solution depending on the risk factor... let’s say a printout document that can tell you what you eat, what lifestyle to live to be able to reduce your risk factor. “In order for you to be at a low risk, you need to do this, this, this and that”... Just to give people some idea of what to do.” |
Checklist of reachable objectives to individualise patient education | FA1: “… perhaps we could have a sort of summary sheet and possibly ask them to read it and come back afterwards with the objectives they would set themselves. For example, “Set yourself one or two goals in this list and come back to see me next time” … a dialogue would take place, and we could slowly try to get them to change their habits.” FA2: “Something like a little sheet to tick off, what we set ourselves as objectives for next week. Let’s say “Come on, next week you won’t put any more sugar in your coffee”… it’s not much, but it’s within people’s reach.” FA3: “There are apps too. Like they could look at what they have on their watch (number of steps) and we can work from there” PA10: “Very concrete things! So, if I’m at risk and there are things that need to be changed, he/she should explain them to me…” PA9: “Small goals so that people don’t get completely discouraged and think “well, it’s impossible to do that anyway.” | ||
Score table can help patients to visualise how they can decrease their risk | FA12: “You need tools that create a trigger to start the dialogue. Very concrete. A score...” FA14: “I think the SCORE table is very precise because it’s like I said, not just at risk or not at risk, it’s a very precise risk.” | ||
Food pyramid and glycemic index table | FA3: “You need blood sugar tables too, I think. I have glycemic tables that I suggest to patients, saying “look at what you can eat... rice, this kind and not that kind...” FA7: “For some people, it’s going to be useful to bring along the nutrition triangle, though… You also need to have suitable material for that.” | ||
Recipes | FA3: “Ideas for dishes, meals, that could be interesting. We could be inspired by what the Belgian Diabetes Association proposes, which provides good information.” FA7: “What is also very nice is bringing their recipes. Let’s say a cake but make it sugar-free cake or something like that.” PA6: “I always like recipe books. Actually, that’s a cool idea, like, a recipe book or something like that.” | ||
Layout | Materials with pictograms, colourful and easy to understand | FA1: “Some pictograms, say what they can act on.” FA3: “(About the emoticon tool) It’s visual, and it could be used as a tool for what we talked about regarding the objectives. Saying, “Look, this is the tobacco you decided on, you’ve reduced that much...” FA3: “… with fairly clear images, more with pictograms… possibly, a sheet a little more detailed with glycemic indexes or have detachable sheets, well.” FA7: “It’s up to us to give them something worthwhile... and understandable, clear. Not too complicated.” FA10: “It should be as visual as possible so that it can be understood in all languages.” FA12: “You have to go as simple as possible with them. This kind of questionnaire with the little drawings is very good.” PA2: “From the position of pharmacist, they can’t do much more than just provide neutral, objective information in an understandable way.” | |
All-in-one: easy to access/classify within the pharmacy. | FA1: “I think we need something really all-in-one, to say “this is what you can do” about diabetes, about physical activity, about diet...” FA2: “You need all-in-one tools that are not too sophisticated... I did my dissertation in tobacco on the ready-to-use kit for the pharmacist, for the management of smoking cessation. There is a display, there is a CO-meter, there are appointment cards with your pharmacist, there are appointment cards with your tabacologues. It’s all-in-one, ready-to-use...” FA7: “(About a display tool) Here, the advantage is that you have a file, you know where it is. It’s practical... Because we have a lot of information, but as you say, you need to classify it.” | ||
Written information | FA7: “I would have liked something to give to the patient. For education... we’re not going to measure them unnecessarily, so when the patient goes out, they should take a little tool with them. Whether it’s a brochure or...“ PA3: “… preferably something that you can take home and that you can talk to your pharmacist about as well.” PA9: “Maybe having it on a folder or something, certainly something I can go back to in case I forget what they said.” PA10: “Not only orally, but that there should be concrete documents to take at home…” PA11: “I read everything by e-mail. So I think that by e-mail, it’s easier than the leaflets.” | ||
Digital game | FA3: “Have you ever thought of having apps? People are all on their mobile phones, with an application where we could use some images too.” FA8: “They are more familiar with health applications.” FA9: “This generation, they are better at using their smartphone.” FA15: “An easy site. Like you show a food. You just have to click on it. It’s good. It’s not good. We’re talking about the basics… in the form of a game.” | ||
Form | Pharmacist needs to address the motivational aspects without inducing guilt. | FA2: “Whether it’s for diabetes or to stop smoking, it’s the same struggle, you have to change your lifestyle... It’s not pleasant. So that means that the interview should not at all be guilt-inducing.” FA3: “For smoking cessation, the first thing they say is something like that: “I’ve already stopped”. “But no, don’t worry, the average is at least 8 attempts. There’s no problem, you’ll get there” and then step by step...” FA15: “It must above all be done in a constructive atmosphere.” PA2: “I also think that should come from a position that really doesn’t come across as patronising. With everything that is known about prevention and healthy lifestyles, I think the main focus should be on nudging and guiding people towards healthier choices and giving them the feeling that this comes from an autonomous movement and not from patronising.” PA9: “Being nuanced… focusing on a healthy eating, healthier living, but not saying “here, you should do hours of sport” or “you should do this or never eat that again”. It seems unreachable.” | |
Do not overflow them with too much information. | FA2: “Not to overload them with information, at first. As time goes by, it will settle down, and we can eventually do a more important interview, more relaxed.” PA10: “… with a jargon that is not accessible to the average person, so not 30 pages of literature. I’ll never look at that. You don’t need too much. Because if you have too much, you do nothing.” | ||
Training | Training in motivational techniques | FA2: “It’s a pity, unfortunately, that training in motivational interviewing is still not included in the curriculum! Whatever care we want to have in all the chronic diseases, it’s the motivational interview that’s the key.” FA8: “Just talking about being overweight is difficult.” FA17: “I always find it difficult to get the message across to them that they should move and eat better.” PA15: “It also comes down to the delivery of that result. How the pharmacist delivers. If they just print out a paper to give to me and say, “you have diabetes”, I’m not going to take them seriously. There needs to be that engagement from the pharmacist.” | |
Training in nutrition for diabetes | FA1: “In relation to diabetes, obviously in this case, something targeted at diabetes.” FA2: “I would say a dietician, who would give some (training).” FA3: “Eventually you need to be prepared too at the nutritional level because in terms of pre-diabetes it is indeed through diet that you act… It’s true that we haven’t been trained in nutrition.” | ||
Multidisciplinary training by specialists | FA1: “What you can do is, for example, take a multidisciplinary team from a hospital that looks after diabetic patients, in a diabetes care pathway, and ask them to come… A team that is really aware of the management of diabetics.” | ||
Practical organisation of the risk evaluation | Awareness | Promotional material to promote the risk evaluation: video fragments, floor mat, web application, leaflets, posters, etc. | FA6: “Short explanatory videos, on the screen for when they are waiting.” FA6: “Window stickers!” FA7: “So at your feet, come to your diabetes... Yes, I think that’s cool too so a floor sticker.” FA12: “A printed bag system for example. That could be quite good… You have to do flyers, bags, posters, etc. Maybe a kit to send out to the pharmacy and then everyone chooses what they want to use… A carpet on the floor could also be good idea.” FA14: “It’s a whole thing. You need flyers for those who can read. You have to talk to those who don’t. We have screens that show advertising.” PA3: “If there’s a poster up, you can recognise some of the characteristics of a disease that you might yourself suffer from...” PA4: “Something very noncommittal, that you can just give it to people. Putting up posters, leaflets, and if people have questions, they can take it with them and look at it at their leisure.” PA5: “It’s mainly mothers who go to the pharmacist. So, if you want to reach a whole family, I think leaflets might help.” PA6: “Some fragments on television, like “talk to your pharmacist about it”... but I think it’s important that you have a reminder in the pharmacy itself. Something that catches the eye and that says: “you can discuss it here with your pharmacist.” PA8: “A poster on the windows of my pharmacy saying: “Do you want to know if you are at risk of having diabetes?” for example. “Take 30 min with your pharmacist”. Well yes, then I would do it more easily anyway.” |
Software | A software for schedule and follow-up | FA2: “The pharmacist must have a tool, an agenda. There are medical diaries, online like doctors have, with the confidentiality space that would eventually managed with slots.” FA3: “it would be worth having a dashboard to have an overview. Here are the patients I referred and here are the others who were borderline, whom I absolutely must follow up because they don’t need to be referred, but they’re still at a risk.” | |
Referral | Referral to specialists who can focus on specific lifestyle habits | FA1: “I think that a partnership with doctors, with medical centers, with dieticians, with physiotherapists, I think it’s ideal because I believe that we need to be able to collaborate with other providers.” FA1: “You have to keep in mind that, you are part of a team that would allow you to be completed by all the care providers in the area. And that’s also important, it’s also to have a list of physiotherapists, dieticians, etc. in the neighbourhood.” FA12: “… or give us a list with the contact details of dieticians who practice in Brussels”. PA8: “I think that can go along the same lines at a GP’s...So actually you can suggest the same thing, or you’re even sent to a dietician.” | |
Leaflet with the results stapled | FA2: “At one point we had a bone densitometry machine at the pharmacy, and we had made a little leaflet saying, here we are, what is osteoporosis, the 10 questions to ask your GP… it could just as well be diabetes.” FA3: “We’ll need a standard accompanying document.” FA7: “You have to have a document to show that you’ve looked at it, that you’ve done this with the patient and that you’ve discovered that there’s a moderate risk and that you’ve given the patient advice. And give this document to the patient so that he can pass it on to his doctor if he wants.” PA10: “I would still like to go and have the results in person, even only to have them myself. That’s important, and because I like to have control over the information that is circulated.” PA11: “I would prefer the pharmacist to write me a kind of little letter... a little summary of the analysis and he gives it to me and I pass it on to my doctor.” | ||
Online platform | FA3: “For the (e-health) platform, it is still an additional task. PA6: “… via the pharmacist, which is an official channel, right? And nowadays there’s a lot more communication between pharmacists and doctors anyway.” PA7: “The first thing that comes to my mind is that there is such a platform with all the documents that the doctor needs, so e.g., the results of a fingerprick test. that would be a good option I think.” |
Appendix B
Diabetes Folder | Cardiovascular Diseases Folder | Lifestyle Patient Booklet | Score a | |||||
---|---|---|---|---|---|---|---|---|
Mean Score by Item (n = 10) | Min | Max | ||||||
Objectives | ||||||||
At first glance, it attracted my attention | 28 | (70%) | 18 | (45%) | 37 | (93%) | 0 | 40 |
It held my attention | 31 | (78%) | 34 | (85%) | 37 | (93%) | 0 | 40 |
It is useful | 33 | (83%) | 32 | (80%) | 39 | (98%) | 0 | 40 |
I would recommend it to a friend or relative to read | 32 | (80%) | 29 | (73%) | 35 | (88%) | 0 | 40 |
Content | ||||||||
I believe what is written | 38 | (95%) | 39 | (98%) | 37 | (93%) | 0 | 40 |
What it says is important | 37 | (93%) | 38 | (95%) | 33 | (83%) | 0 | 40 |
It reminds me of some things I need to think about | 33 | (83%) | 36 | (90%) | 37 | (93%) | 0 | 40 |
It gives me new ideas or leads to implement. | 15 | (38%) | 17 | (43%) | 31 | (78%) | 0 | 40 |
It breaks down the advice into achievable steps for me | 35 | (88%) | 0 | 40 | ||||
It changes some of my thinking | 24 | (60%) | 9 | (23%) | 19 | (48%) | 0 | 40 |
It could change how I do things | 23 | (58%) | 19 | (48%) | 29 | (73%) | 0 | 40 |
Layout | ||||||||
It is easy to read | 35 | (88%) | 32 | (80%) | 37 | (93%) | 0 | 40 |
It is easy to understand | 38 | (95%) | 34 | (85%) | 38 | (95%) | 0 | 40 |
I like the illustrations | 31 | (78%) | 27 | (68%) | 38 | (95%) | 0 | 40 |
The illustrations are easy to understand | 37 | (93%) | 30 | (75%) | 38 | (95%) | 0 | 40 |
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Flip over Album | Folder on Diabetes and Cardiovascular Disease | Lifestyle Patient Booklet |
---|---|---|
Protocol steps of the risk evaluation
| Diabetes:
| Chapter 1: Healthy Eating
|
Characteristics | Folder Diabetes | Folder CVDs | Lifestyle Patient Booklet |
---|---|---|---|
Participants (n) | 10 | 10 | 10 |
Male | 3/10 | 4/10 | 5/10 |
Female | 7/10 | 6/10 | 5/10 |
Age | |||
25–35 years | 1/10 | 2/10 | 4/10 |
36–45 years | 3/10 | 2/10 | 1/10 |
46–55 years | 2/10 | 2/10 | 2/10 |
56–65 years | 4/10 | 4/10 | 3/10 |
Education level | |||
Primary school | 2/10 | 2/10 | 1/10 |
High school | 3/10 | 2/10 | 4/10 |
Bachelor’s degree | 3/10 | 4/10 | 4/10 |
Master’s degree | 2/10 | 2/10 | 1/10 |
Interview duration range (mean) | 11–62 (27 min) | 8–25 (16 min) | 9–42 (22 min) |
Participants (n) | 16 |
---|---|
Male | 6/16 |
Female | 10/16 |
Age | |
25–35 years | 2/16 |
36–45 years | 6/16 |
46–55 years | 4/16 |
56–65 years | 4/16 |
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Rondeaux, S.; Braeckman, T.; Beckwé, M.; El Oueriaghli El Ghammaz, D.; Devroey, D.; De Vriese, C. Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy. Int. J. Environ. Res. Public Health 2023, 20, 2819. https://doi.org/10.3390/ijerph20042819
Rondeaux S, Braeckman T, Beckwé M, El Oueriaghli El Ghammaz D, Devroey D, De Vriese C. Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy. International Journal of Environmental Research and Public Health. 2023; 20(4):2819. https://doi.org/10.3390/ijerph20042819
Chicago/Turabian StyleRondeaux, Sarah, Tessa Braeckman, Mieke Beckwé, Dounia El Oueriaghli El Ghammaz, Dirk Devroey, and Carine De Vriese. 2023. "Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy" International Journal of Environmental Research and Public Health 20, no. 4: 2819. https://doi.org/10.3390/ijerph20042819