Can group education reduce fear of hypoglycaemia as a barrier to physical activity in people living with type 1 diabetes?

The group, self-management workshop, ‘Type 1 TACTICS for Exercise’ will be the intervention under investigation. The intervention encourages group exploration of beliefs surrounding fear of hypoglycaemia as a barrier to Physical Activity (PA), before building knowledge using Dual Processing Theory and finally problem solving strategies to address this barrier. Throughout the three hour intervention, participants will be given the opportunity to explore the following topics throughout the intervention: pathophysiological effects of exercise in people with type 1 diabetes, barriers to PA, strategies to overcome barriers, insulin pharmacokinetics, specific strategies to manage Blood Glucose Levels (BGLs) during exercise, goal setting and general safety considerations. Grounded by the positive outcomes and behaviour change observed in the DESMOND program (Davies et al., 2008), the facilitator will draw on Social Learning Theory (Bandura, 1977) and to a lesser extent, Dual Processing Theory (Chaiken, Wood, & Eagly, 1996) and Leventhal’s Common Sense Model (Dieffenbach & Leventhal, 1996) to deliver the program content. A ‘booster’ one-hour workshop (intervention - part II) will be held four weeks following intervention part I. The intervention arm will also have access to an ongoing, private social media page for those who have completed the intervention – part I. A private social media page will be offered to graduates of part I of the intervention to allow ongoing peer discussion and problem solving as participants try new strategies to manage BGLs for PA, while networking with like-minded individuals. The interventions will be held in areas north and south of Perth metropolitan area, Western Australia. Intervention – part I. The group, self-management workshop, ‘Type 1 TACTICS for Exercise’ will be the intervention under investigation. Groups of 10 participants will meet face to face in a group setting for part I and part II of the intervention and control arms. The intervention encourages group exploration and discussion of beliefs surrounding FoH as a barrier to PA, before building knowledge using Dual Processing Theory and finally problem solving strategies to address this barrier. Participants will be given the opportunity to explore the following topics throughout the intervention: pathophysiological effects of exercise in people with T1D, barriers to physical activity, strategies to overcome barriers, insulin pharmacokinetics, specific strategies to manage BGLs during exercise, goal setting and general safety considerations. Intervention content relating to current evidence based strategies to manage BGLs for PA was based on the consensus statement by Riddell et al. (2017). Grounded by the positive outcomes and behaviour change observed in the DESMOND program (Davies et al., 2008), the facilitator will draw on Social Learning Theory (Bandura, 1977) and to a lesser extent, Dual Processing Theory (Chaiken, Wood, & Eagly, 1996) and Leventhal’s Common Sense Model (Diefenbach & Leventhal, 1996) to deliver the program content. The workshop will be run over a three-hour period by a facilitator (the PhD candidate) who is an Accredited Exercise Physiologist, Credentialed Diabetes Educator and Accredited DESMOND facilitator, with extensive knowledge and qualifications in the area of diabetes and exercise. The private social media page will be offered to graduates of part I of the intervention to allow ongoing peer discussion and problem solving as participants try new strategies to manage BGLs for PA, while networking with like-minded individuals. Participants will have the opportunity to post their questions and experiences as well as comment and contribute to other forum conversations. Participation in the social media page will be voluntary. The page will be administered and mediated by the intervention facilitator and monitored at least once per day during the intervention phase. The facilitator will be available to help direct conversation, ensure safe advice is being offered and to ensure appropriate etiquette is being followed by all group members. All participants will be given the facilitator’s email contact details should they prefer this mode of contact. Social media utilisation and frequency will be measured using a questionnaire item as well as by collecting social media platform data. Qualitative focus groups will also explore participant’s experience of this aspect of the intervention. Intervention – part II. Participants will be asked to attend a one hour follow up ‘booster’ session (intervention – part II) four weeks following intervention – part I which will be facilitated by the same educator from part 1. Participants will be asked to return for the booster session with an example of their experience using different strategies to manage BGLs for PA. An icebreaker activity relating to common themes found on the social media page will also be used to initiate discussion. Participants will problem solve as a group using the ‘timeline’ activity used in intervention - part I. Bandura’s Social Learning Theory suggests individual’s change in self-efficacy are derived from four sources: performance accomplishments, vicarious experience, verbal persuasion and physiological states (Bandura, 1977). The booster session will allow for greater exploration of these four sources after participants have had the opportunity to go away and experience and master new skills. Ongoing exploration of these experiences with their peers in the booster session and via social media will further consolidate self-efficacy. In an effort to standardise the delivery and limit variability of the intervention and control, clear program aims and objectives exist along with a facilitator manual outlining key content and messages to be covered in each section. To further improve fidelity, all interventions and control groups will be facilitated by the same person. With permission of participants, video of three intervention and three control workshops (Part I and II) will be recorded to enable assessment of facilitator behaviours. Observed facilitator behaviour will be assessed using specifically designed assessment tools and facilitator talk time as recommended by Skinner et al. (2008). Intervention and control group content will also be examined using these video recordings to ensure key messages (as set out in the program manual) are consistently being covered. Assessment will be conducted by an independent experienced program assessor from Diabetes WA.