Developing an intervention to reduce diabetes distress in couples living with Type 2 diabetes: theory vs. real life

Aims: The challenges of shifting deep-rooted lifestyle habits and ‘making room’ for diabetes can lead to significant emotional distress and can put a strain on relationships. Despite evidence revealing the psychosocial affliction of Type 2 diabetes on individuals and their partners, few interventions have been developed to specifically address the needs of couples who are struggling to cope. This study assessed the feasibility of a brief psychoeducational intervention developed to address diabetes distress in people with Type 2 diabetes (PWT2D) and their partners. Methods: An explanatory mixed methods design was used to assess the recruitment, implementation, and acceptability of the intervention developed. PWT2D were recruited by post from a register of Type 2 structured diabetes education completers. Ten PWT2D and four partners attended a one-day intervention (approximately six hours of content) (N=14). The intervention ran on two occasions, with five PWT2D and two partners attending each day. The intervention was facilitated by a Clinical Health Psychologist and a PhD Psychology student. Baseline and post-intervention surveys were used to measure change in diabetes distress (Diabetes Distress Scale), diabetes perceptions (Brief Illness perception Questionnaire), and diabetes empowerment (Diabetes Empowerment Scale). Telephone interviews took place 1 month post-intervention to explore experiences of the intervention and perceived change since attending the intervention. Within-subjects t-tests and effect size calculations were used to examine change in pre-post intervention survey scores. Interviews were analysed thematically. A postal survey was also administered to non-responders to explore the low uptake (5%) for the intervention. Results: There was a trend for reduced regimen-related distress post-intervention, but there was little change in diabetes distress overall. PWT2D diabetes empowerment (d=0.54), treatment control perceptions (d=0.68), and concern (d=0.69) increased with a medium effect, and personal control increased with a large effect (d=0.90). Partners’ treatment control perceptions increased with a medium effect (d=0.84). Themes relating to the perceived benefits of the intervention or perceived change since attending the intervention at follow-up included: ‘Awareness of how other people feel about Type 2 diabetes’, ‘feeling in control’, ‘positive perspective’, and ‘interacting with others’. Common reasons for the low-uptake as revealed by the postal survey for non-responders (N=110) included ‘intervention on emotional issues not needed’ (32.7%), ‘intervention too long’, (22.7%), and ‘other reasons’ (self-reported physical/medical issues and other commitments) (35.4%). Conclusions: Baseline diabetes distress was low in PWT2D and partners, which may account for the lack of change post-intervention. Despite this, the change in diabetes perceptions, diabetes empowerment and the themes reported, suggest that the intervention was beneficial—perhaps as a source of preventative emotional support. Significant recruitment challenges and implications for future intervention strategies are discussed.