title: Explaining engagement in self-monitoring among participants of the DESMOND Self-monitoring Trial: a qualitative interview study.
abstract: BACKGROUND
  The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and randomized to self-monitoring of blood glucose (SMBG) or urine monitoring had comparable improvements in biomedical outcomes, but differences in satisfaction with, and continued use of monitoring method, well-being and perceived threat from diabetes.
  
  
  OBJECTIVE
  To explore experiences of SMBG and urine monitoring following structured education. We specifically addressed the perceived usefulness of each monitoring method and the associated well-being.
  
  
  METHODS
  Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial (SMBG, N=10; urine monitoring, N=8)~12 months into the trial. Analysis was informed by the constant comparative approach.
  
  
  RESULTS
  Interviewees reported SMBG as accurate, convenient and useful. Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals. Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy, leading some to switch to SMBG. Perceiving diabetes as less serious was attributable to lack of symptoms, treatment with diet alone and-in the urine-monitoring group-consistently negative readings. Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose.
  
  
  CONCLUSIONS
  The findings highlight the importance for professionals of considering patients' preferences when using self-monitoring technologies, including how these change over time, when supporting the self-care behaviours of people with type 2 diabetes.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK, hce3@le.ac.uk.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Eborall
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Leicester Clinical Trials Unit, University of Leicester, Leicester, UK.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Dallosso
authors.affiliation: Education and Social Research Institute, Manchester Metropolitan University, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: McNicol
authors.affiliation: AHP Research, Hornchurch, UK, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia, Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Victoria, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Diabetes Research Centre, University of Leicester, Leicester, UK and.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK, Diabetes Research Centre, University of Leicester, Leicester, UK and.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Department of Human Metabolism, University of Sheffield, Sheffield, UK.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Heller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000652:urine*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D057240:Patient Preference; D036301:Qualitative Research; D016482:Urinalysis
keywords: Blood glucose self-monitoring; education; primary health care; self-care; type 2 diabetes mellitus; urinalysis.