title: Diabetes self-management education: acceptability of using trained lay educators.
abstract: BACKGROUND
  The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education. This qualitative substudy is embedded within an equivalence trial (2008-2011 including development stage).
  
  
  OBJECTIVE
  In the qualitative substudy, we aimed to elicit the views of key stakeholders (patients, educators) about using lay people to deliver education to people recently diagnosed with type 2 diabetes, alongside a healthcare professional educator with an equal role. In this way, we sought to explore perceptions about acceptability and also contribute to understanding the reasons underlying positive or negative quantitative findings from main trial.
  
  
  METHODS
  We conducted 27 telephone interviews with a purposive sample of patients, lay educators and healthcare professional educators involved in the main trial. Thematic analysis of transcribed data was underpinned by the constant comparative approach and structured using Framework methodology.
  
  
  RESULTS
  Overall, the data suggested that the use of lay educators was acceptable to educators and patients. Perceived difference in knowledge levels between lay and healthcare professional educators did not appear to have an impact on perceived acceptability or the effectiveness of the education received. Additional themes explored were related to peer status of educators and feasibility. Some concerns were raised about lay educators with diabetes, transferring personal issues and about the impact of healthcare professional time taken up by mentoring and supporting lay educators.
  
  
  CONCLUSIONS
  Positive perceptions about the use of lay educators support the positive quantitative findings from the main trial. Acceptability is an important consideration in relation to implementation of the model of delivery studied. Concerns raised within the interviews should be considered in the design of training for lay educators.
  
  
  BACKGROUND
  ISRCTN 99350009.
authors.affiliation: Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Mandalia
authors.affiliation: Diabetes Research Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Stone
authors.affiliation: Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Carey
mesh_terms: D001291:Attitude of Health Personnel; D003150:Community Health Workers / Q000193:education* / Q000458:organization & administration / Q000523:psychology; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training; D008297:Male; D010353:Patient Education as Topic / Q000458:organization & administration*; D010379:Peer Group; D024382:Professional Role / Q000523:psychology; D015397:Program Evaluation; D036301:Qualitative Research; D012648:Self Care; D020377:Self Efficacy
keywords: DIABETES & ENDOCRINOLOGY; EDUCATION & TRAINING (see Medical Education & Training)