. 2016 Apr 13;6(4):e010254. doi: 10.1136/bmjopen-2015-010254

Table 2.

Overview of subgoals and strategies of Powerful Together with Diabetes

General objective	Subgoals	Intervention strategies
1. Extending participants' diabetes-related social networks, facilitating the exchange of social support and positive social influences with group members.	Participants positively influence each other (role models, positive peer pressure, positive group norms). Participants encourage and support each other in adhering to their self-management during the intervention and continue to support each other after the intervention has ended (advice, helping each other). Participants continue to see each other after the intervention and continue to do DSM-related activities together (eg, exercising).	Group meetings for patients with diabetes, phases 1 and 2 Participants took part in interactive games and energisers (short breaks during the intervention to keep the participants motivated and concentrated during the rest of the programme). Energisers often consisted of short exercises aimed at group bonding (eg, throwing a balloon back and forth while giving each other compliments) Participants had to team up with someone or form alliances. They were encouraged to open up to each other through these games and energisers. Participants were regularly invited to talk about their self-management problems and to ask group members for advice. To do this, the group members learnt skills for giving constructive feedback. In small subgroups, participants did assignments in which they had to help each other (eg, adjusting recipes together) to get used to giving and receiving social support. Participants were encouraged to phone and/or meet up with each other outside of the group meetings. Group meetings for patients with diabetes, phase 2 Periodic (first two weekly, then monthly) meetings were held. Participants were encouraged to continue seeing each other in between group meetings without the group leader.
2. Increasing participants’ abilities to handle social influences that hinder their self-management, such as norms, peer pressure and temptations.	Participants critically evaluate the impact significant others have on their DSM. Participants are better able to deal with social influences that hinder their self-management, such as peer pressure (eg, pressure to eat unhealthy foods or to overeat, or negative feedback when exercising or taking medications).	Group meetings for patients with diabetes, phase 1 Group discussions were held about social situations in which managing diabetes is difficult (in response to a DVD, a letter of the week and of their own accord). Participant practised these strategies with group members during role-playing exercises. Group meetings for patients with diabetes, phase 2 An action plan was drawn up in which social influences and dealing with social influences played an important part (group meetings). Together with other group members, the person with diabetes came up with strategies and solutions to overcome these difficulties.
3. Increasing the engagement and support of the participants’ significant others in self-management.	Participants ask significant others for support. Participants indicate that their significant others are more involved in their self-management (providing more support or more enabling social influences). Participants experience more enabling social influences. Participants experience fewer social influences from their significant others that hinder their self-management.	Group meetings for patients with diabetes, phase 1 Participants were encouraged to tell their significant others they have diabetes (if they did not know). Participants were encouraged to tell their significant others about the negative social influences and barriers they face (social network therapy). Social network therapy session, phase 2 Participants discussed solutions and strategies with their significant others to deal with negative social influences on self-management. Together with their significant others, participants agreed on an action plan in which the significant others play an active role in their self-management. In this action plan, the participant and his/her significant other(s) described the problem they would be working on and barriers and facilitators to overcome this problem. Finally, they agreed on some concrete appointments with each other to overcome this problem. Group meetings for significant others, phases 1 and 2 Significant others learnt more about diabetes and the important role they play in the self-management of the patient with diabetes. To change their norms regarding self-management tasks, the significant others critically evaluated their own lifestyles through interactive games. Significant others did interactive assignments in which they distinguished helpful and non-helpful behaviour with regard to self-management. Group discussions were held about ways to better facilitate the self-management of their relative with diabetes. Significant others learnt ways to ask about their relative's self-management in a friendly, supportive way (group meetings for significant others).

General objective

Subgoals

Intervention strategies

1. Extending participants' diabetes-related social networks, facilitating the exchange of social support and positive social influences with group members.

Participants positively influence each other (role models, positive peer pressure, positive group norms).
Participants encourage and support each other in adhering to their self-management during the intervention and continue to support each other after the intervention has ended (advice, helping each other).
Participants continue to see each other after the intervention and continue to do DSM-related activities together (eg, exercising).

Group meetings for patients with diabetes, phases 1 and 2

Participants took part in interactive games and energisers (short breaks during the intervention to keep the participants motivated and concentrated during the rest of the programme). Energisers often consisted of short exercises aimed at group bonding (eg, throwing a balloon back and forth while giving each other compliments)
Participants had to team up with someone or form alliances. They were encouraged to open up to each other through these games and energisers.
Participants were regularly invited to talk about their self-management problems and to ask group members for advice. To do this, the group members learnt skills for giving constructive feedback.
In small subgroups, participants did assignments in which they had to help each other (eg, adjusting recipes together) to get used to giving and receiving social support.
Participants were encouraged to phone and/or meet up with each other outside of the group meetings.

Group meetings for patients with diabetes, phase 2

Periodic (first two weekly, then monthly) meetings were held. Participants were encouraged to continue seeing each other in between group meetings without the group leader.

2. Increasing participants’ abilities to handle social influences that hinder their self-management, such as norms, peer pressure and temptations.

Participants critically evaluate the impact significant others have on their DSM.
Participants are better able to deal with social influences that hinder their self-management, such as peer pressure (eg, pressure to eat unhealthy foods or to overeat, or negative feedback when exercising or taking medications).

Group meetings for patients with diabetes, phase 1

Group discussions were held about social situations in which managing diabetes is difficult (in response to a DVD, a letter of the week and of their own accord).
Participant practised these strategies with group members during role-playing exercises.

Group meetings for patients with diabetes, phase 2

An action plan was drawn up in which social influences and dealing with social influences played an important part (group meetings). Together with other group members, the person with diabetes came up with strategies and solutions to overcome these difficulties.

3. Increasing the engagement and support of the participants’ significant others in self-management.

Participants ask significant others for support.
Participants indicate that their significant others are more involved in their self-management (providing more support or more enabling social influences).
Participants experience more enabling social influences.
Participants experience fewer social influences from their significant others that hinder their self-management.

Group meetings for patients with diabetes, phase 1

Participants were encouraged to tell their significant others they have diabetes (if they did not know).
Participants were encouraged to tell their significant others about the negative social influences and barriers they face (social network therapy).

Social network therapy session, phase 2

Participants discussed solutions and strategies with their significant others to deal with negative social influences on self-management.
Together with their significant others, participants agreed on an action plan in which the significant others play an active role in their self-management. In this action plan, the participant and his/her significant other(s) described the problem they would be working on and barriers and facilitators to overcome this problem. Finally, they agreed on some concrete appointments with each other to overcome this problem.

Group meetings for significant others, phases 1 and 2

Significant others learnt more about diabetes and the important role they play in the self-management of the patient with diabetes.
To change their norms regarding self-management tasks, the significant others critically evaluated their own lifestyles through interactive games.
Significant others did interactive assignments in which they distinguished helpful and non-helpful behaviour with regard to self-management.
Group discussions were held about ways to better facilitate the self-management of their relative with diabetes.
Significant others learnt ways to ask about their relative's self-management in a friendly, supportive way (group meetings for significant others).

DSM, diabetes self-management.