Paul GM, Smith SM, Whitford D, O'Kelly F, O'Dowd T, Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes, BMC Health Services Research, 7, 2007, 136
7 BMC Health Services Research
Background: Diabetes is a chronic illness which requires the individual to assume responsibility
for their own care with the aim of maintaining glucose and blood pressure levels as close to normal
as possible. Traditionally self management training for diabetes has been delivered in a didactic
setting. In recent times alternatives to the traditional delivery of diabetes care have been
investigated, for example, the concept of peer support which emphasises patient rather than
professional domination. The aim of this paper is to describe the development of a complex
intervention of peer support in type 2 diabetes for a randomised control trial in a primary care
Methods: The Medical Research Council (MRC) framework for the development and evaluation
of complex interventions for randomised control trials (RCT) was used as a theoretical guide to
designing the intervention.
The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in
depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer
support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were
combined to define the main components of the intervention. The preliminary intervention was
conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24
patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to
collect additional qualitative data to inform the development of the intervention.
Results: The four components of the intervention were identified from the Preclinical Phase and
Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer
supporters; 4.Peer support meetings. The preliminary intervention was implemented in the Phase
2. Findings from this phase allowed further modeling of the intervention, to produce the definitive
Conclusion: The MRC framework was instrumental in the development of a robust intervention
of peer support of type 2 diabetes in primary care.
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