title: Harvesting experiential expertise to support safe driving for people with diabetes mellitus: a qualitative study evaluated by peers in a survey.
abstract: BACKGROUND
  Hypoglycemia is a frequent phenomenon in people being treated for diabetes mellitus, which can acutely disrupt driving performance. For the benefit of personal and public traffic safety, we decided to identify successful diabetes-related (SDR) behaviors to support safe driving for people with diabetes, from the perspective of experiential experts with diabetes mellitus. Experiential experts are people who can manage their own illness and conditions by developing expertise relevant to maintaining health and countering illness, and who are able to use this expertise to the benefit of peers.
  
  
  OBJECTIVE
  The aim of our study was to objectify and systematize experiential expertise in terms of SDR behaviors, based on reports by experiential experts, to support safe driving for people with type 1 and type 2 diabetes mellitus. The emphasis was on preventing hypoglycemia as a short-term complication during driving.
  
  
  METHODS
  We performed a mixed-methods study involving (i) semi-structured in-depth interviews with 33 experiential experts with diabetes mellitus from the Dutch Diabetes Association (DVN; Diabetesvereniging Nederland), in order to identify SDR behaviors regarding safe driving, and (ii) a validation study by means of a survey among a panel of 98 experiential experts (peers) from the DVN, to determine the extent to which they agreed with the communicability, importance, and feasibility of these behaviors for drivers with diabetes mellitus.
  
  
  RESULTS
  We identified a comprehensive set of 11 SDR behaviors, differentiated into seven general and four specific behaviors, to support safe driving. The general behaviors concern the following topics: (i) acquiring knowledge and information; (ii) acquiring and using self-measuring of blood glucose (SMBG) equipment; (iii) knowing one's physical response pattern; (iv) obtaining knowledge about the medication used; (v) preventing long-term eye complications; (vi) influencing factors that can affect blood glucose; and (vii) renewal procedure for driving license. The four specific behaviors refer to the following topics: (i) measures to be taken before driving; (ii) responding effectively to hypoglycemia while driving; (iii) informing and instructing passengers; and (iv) preventing hypoglycemia in drivers with type 2 diabetes mellitus not using SMBG equipment. Key factors for safe driving proved to be the ability of drivers to anticipate and respond effectively to hypoglycemia while driving and to inform and instruct fellow passengers. Participants of the validation survey agreed to a considerable degree with the communicability, importance, and feasibility of these behaviors to support safe driving for people with diabetes mellitus.
  
  
  CONCLUSIONS
  This study resulted in the identification and description of SDR behaviors to support safe driving. It proved possible to operationalize experiential expertise in terms of such behaviors. The next step is to have these behaviors validated by professional care providers in the field of diabetes, followed by translation into recommendations in self-management programs.
authors.affiliation: Department of General Practice, Maastricht University, Maastricht, the Netherlands. marika.burda@maastrichtuniversity.nl
authors.forename: Marika H F
authors.initials: MH
authors.lastname: Burda
authors.forename: Frans
authors.initials: F
authors.lastname: van der Horst
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.forename: Alexander D M
authors.initials: AD
authors.lastname: Stork
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.forename: Silvia
authors.initials: S
authors.lastname: Bours
authors.forename: Maarten
authors.initials: M
authors.lastname: Ploeg
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving; D015190:Blood Glucose Self-Monitoring; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D036301:Qualitative Research