title: A qualitative evaluation of DAFNE-HART: A psychoeducational programme to restore hypoglycaemia awareness.
abstract: OBJECTIVE
  Impaired awareness of hypoglycaemia (IAH) in people with type 1 diabetes is a dangerous condition that is associated with a six-fold greater risk of severe hypoglycaemia than for people with awareness. A new psychoeducational programme, DAFNE-HART, has been specifically designed to address persistent IAH. The initial pilot showed promising outcomes including fewer hypoglycaemic episodes and improved hypoglycaemia awareness. This aim of this paper is to report the development and qualitative evaluation of DAFNE-HART from participant interviews.
  
  
  METHODS
  DAFNE-HART incorporates diabetes education with two psychological approaches that have demonstrated efficacy in long-term health conditions: motivational interviewing and cognitive behaviour therapy. The course, delivered across two UK locations included both group and individual support over a 6-week period facilitated by DAFNE educators, trained and supervised by a clinical psychologist. Semi-structured interviews were conducted with 19 participants immediately after their courses and the interviews were analysed using grounded theory.
  
  
  RESULTS
  Five main themes emerged which describe the behavioural changes people made to their diabetes management, the development of new attitudes and beliefs, their experiences of regaining hypoglycaemia cues, reactions to the course format and the significance of the relationship with their care provider. Participants provide insights into how the course changed their view of IAH and led to practical changes in minimising hypoglycaemia.
  
  
  CONCLUSIONS
  Integration of psychological techniques into diabetes education can address the cognitive and motivational barriers to restoring awareness and optimal diabetes management. It is suggested that further research is needed to evaluate this programme in a larger sample, over a longer time frame.
authors.affiliation: Diabetes and Nutritional Sciences Division, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK. Electronic address: eshuttlewood@nhs.net.
authors.forename: Emma
authors.initials: E
authors.lastname: Shuttlewood
authors.affiliation: Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK. Electronic address: ndezoysa@nhs.net.
authors.forename: Nicole
authors.initials: N
authors.lastname: De Zoysa
authors.affiliation: Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK. Electronic address: a.d.rankin@ed.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Rankin
authors.affiliation: Diabetes and Nutritional Sciences Division, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK. Electronic address: stephanie.amiel@kcl.ac.uk.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amiel
mesh_terms: D000328:Adult; D001364:Awareness; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D007003:Hypoglycemia / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D062405:Motivational Interviewing / Q000379:methods*; D010353:Patient Education as Topic
keywords: Cognitive behaviour therapy; Hypoglycaemia; Motivational interviewing; Psychoeducation; Qualitative; Type 1 diabetes