Table 4 Joint display summarising survey and interview data from PWD and staff
Process evaluation components | Survey data | Interview data | |||
|---|---|---|---|---|---|
PWD data | Staff data | PWD data | Staff data | ||
Implementation | Implementation process & delivery | • 29.3%a reported receiving the booklet | • 22.5% often & 28.8% always gave out the booklet to eligible PWD | 2 out of 5 interviewed PWD had received or remembered having received a booklet | • Successfully implemented the intervention with the majority of eligible PWD • Some were never told about the booklets/intervention |
Fidelity | No relevant data. | • 46.3% always completed all sections of the booklet | No relevant data. | • Implemented as instructed to | |
Training | No relevant data. | 10.0% of staff reported receiving training. All agreed that the training was timely, relevant, and sufficient | No relevant data. | Timely and relevant Most did not receive training | |
Resources | No relevant data. | 78.0% did not need any support implementing the intervention 72.9% felt that colleagues could help with and 74.6% that colleagues could answer questions about the intervention, if needed | No relevant data. | Could rely on a colleague/contact researcher for guidance | |
Mechanisms of impact | Reception of the intervention | 66.6% were happy to receive the booklet and the extra advice they were given | 49.2% felt that PWD found the intervention helpful | Felt the booklet would be more useful to someone with less experience or who cannot manage their diabetes well | Most were receptive, but some not as much (booklet was extra work) Felt that most PWD were receptive and found it useful, but for some it was too much to read Very experienced & newly diagnosed PWD, who were in denial, were less receptive |
Acceptability of the intervention | 50.0% felt there was a need for such an intervention & 75.0% that the booklet did meet their needs 80% felt it was easy to understand how to use the booklet 80.0% felt it was easy to follow the advice given by the ambulance staff 75.0% felt that the booklet added value to the care they received | 67.2% said there was a need for such an intervention & 63.1% that the booklet met the needs of the PWD 33.8% found the intervention easy to implement & 15.6% very easy to implement (neutral = 37.7%) 44.30% were very confident & 11.4% extremely confident implementing it 75.4% felt that participating in the intervention fitted well with their existing work 69.2% felt that delivering this intervention added value to attending to the PWD | Booklet was easy to read/understand Booklet was a good summary of advice and information One PWD felt the booklet included incorrect or outdated information and was inappropriate for PWD on pumps | There was a need for such an intervention (safety netting & reminder for PWD) Easy to implement Fits well with existing role & workload Enhanced or complemented care Booklet was easy to read and understand, informative, useful as a record of care, an addition to or continuation of care | |
Experience with the intervention | 41.6% felt that being given this booklet had made things easier for them | No relevant data. | Most didn’t learn anything new from booklet Potentially more useful to someone with less experience | Overall positive | |
Context | Barriers to implementation | No relevant data. | No relevant data. | For newly diagnosed PWD or those with accompanying issues it is harder to cope with managing diabetes | Booklets were not always readily available Implementing the intervention with PWD who were reluctant to accept the booklet Being unable to reach physicians to complete patient safety-netting |
Facilitators to intervention | No relevant data. | No relevant data. | The attitudes of PWD, their motivation, & willingness to assume responsibility for managing diabetes | The attitudes of PWD, their motivation, & willingness to assume responsibility for managing diabetes Being an experienced professional helps overcome potential implementation-related difficulties | |
Attitudes | 63.7% felt that booklets have the ability to change everyday behaviour of PWD | 71.9% felt that implementing the HS2 booklet had improved their feeling that quality improvement interventions are helpful for PWD | Booklets are not appropriate or sufficient to affect change in patient behaviour | Some felt booklets are not enough to change patient behaviours Others felt booklets can indeed affect change in patient behaviours Research can help advance care and improve outcomes for patients | |
Organisational culture | No relevant data. | Staff members felt that their organisation’s culture of safe care (66.7%) and improvement culture (61.7%) supported the implementation of the intervention Staff members felt that implementing this intervention had also affected their organisation’s patient safety (16.67%) and quality improvement (20.0%) culture | No relevant data. | Organisational culture contributed positively to the success of the intervention and vice versa | |
Outcomes | Changed patient behaviours | 50.0% found the intervention to be beneficial (neutral = 41.7%) Receiving the booklet reminded/encouraged: ▪ 18.9% to have a chat/check up with their GP ▪ 45.5% to have a chat/check up with their diabetes consultant ▪ 20% to adjust their medication ▪ 54.6% to test their blood glucose more often ▪ 45.5% to adjust their diet ▪ 27.3% to avoid alcohol for 24 h ▪ 30.0% to reduce their overall alcohol consumption ▪ 90.0% to exercise more ▪ 20.0a% to not drive or operate machinery for at least 12 h ▪ 30% to avoid strenuous activity for 24 h. 30% felt that having received the booklet, their behaviour had changed for the better 77.7% also felt that having received advice from the ambulance staff, had changed their behaviour for the better | 87.93% felt that the intervention had been beneficial to PWD 60.3% felt that the intervention might enhance self-care | One PWD felt that booklets cannot make a difference. One PWD felt that the booklet had been beneficial, mainly as a reminder to be more careful. PWD who had not received (or could not remember receiving) a booklet felt that they were already aware of the information and advice included in the booklet, so most likely it would not have made a difference to them | Most felt that the intervention had been beneficial to PWD |
Prevention of second hypo | 36.3% felt that having the HS2 booklet might prevent recurrent hypoglycaemia episodes (neutral = 63.7%) | 41.4% felt that the intervention might prevent recurrent hypoglycaemia episodes | No relevant data. | Uncertain about its outcomes (crew members do not receive any feedback on the progress of the PWD after leaving the scene) | |
Reduction of repeat ambulance attendances for hypos | No relevant data. | 41.4% felt that the intervention might reduce repeat ambulance attendances for hypoglycaemia episodes | No relevant data. | Never had to attend to the same PWD twice for a repeat hypoglycaemic event | |
Other | No relevant data. | No relevant data. | No relevant data. | Staff now more aware that repeat hypoglycaemic events can happen often | |