| Perceived highlights |
“Most useful section was the ASK section as it gave practical tips on asking questions that will bring up any issues.” (Dietitian, male, eating problems) “I really liked the quotes from practice nurses and quotes from health professionals and quotes from consumers. I thought that was a nice value add. And, I liked the ‘ABCs of effective communication.’” (Dietitian, female, diabetes distress) “Loved the summary cards and felt that this was the handbook's biggest strength.” (Nurse practitioner, female, depression) “Irena [case study]…that would be a very common scenario…I thought it was a great example, and it's brief, it's not too lengthy. And then it sets out the 7 A’s framework in each section of what you can do…. so it's easy for the practitioner to work with that.” (Registered nurse-diabetes educator, female, fear of hypoglycemia) “I’m quite visual in my learning, so, when I’m trying to think about structures in my head, I think visually and I like colors… I like the approach of it.” (Registered nurse, female, diabetes distress) “The structure is well laid out and it certainly follows the 7 A’s model very well. All the chapters have done that, which is exactly what you want. You want consistency so that the reading is streamlined and everyone who reads it can access what they want very quickly.” (GP, male, fear of hypoglycemia)
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| Role of health professionals |
“I think that the one thing that the handbook says… that comes out in every chapter, at every appointment, ask about their well-being. Don't just assume they're okay …ask the question.” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia) “For me, this book has really normalized that our role is working with a whole person, their emotional health and their physical health… sometimes in the rush of everything, and especially in a tertiary setting, you can get quite focused on the physical aspect of somebody who’s acutely unwell… I found it a really useful tool to just ensure that we all keep in mind that we’re working with a person.” (Registered nurse, female, diabetes distress) “I think the point that kept coming through… most people actually do want to go to a member of their diabetes team to talk about this. So, if my question was, you know, is this my role? Well, yeah, it is. They’re seeing it as my role.” (Dietitian, female, diabetes distress)
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| Encourage self-reflection |
“I think it's a really good way to actually reflect back on… your own thoughts and about how you actually engage in asking about diabetes distress.” (Nurse practitioner-credentialed diabetes educator, female, diabetes distress) “I used the Diabetes Distress chapter more for like, a concrete reflection on my practice.” (Registered nurse, female, diabetes distress) “I discussed it with a Type 1 client and we've made an arrangement that next time that she has an appointment that we will discuss her views on this, because it's something that I feel that I could do better on it as a clinician.” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia)
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| Build self-confidence |
“And, the other comment that’s interesting is that diabetes distress is best managed within the context of diabetes care… [it] improves my confidence and I think ‘yeah – that’s what I do with people’ and just talking through their feelings and what’s an issue for them – that I’m doing the right thing… Which is such a feeling of relief really.” (Dietitian, female, diabetes distress) “That 7A’s thing, it really worked. I was nicely surprised. Yeah. And, it felt like I didn’t do anything different to what I normally do, but, I had a language for it. So, that I could work it through for myself.” (Registered nurse, female, diabetes distress)
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| Influence clinical practice |
“I was reading the handbook before the patient came in two days ago and I said to her, 'How are you going? How are you feeling about everything? Are you managing things?...I realized it was a real can of worms … it was not just about her diabetes. It was about feeling overwhelmed…She actually ended up saying to me, ‘The only reason why this conversation's coming out is because you asked me how I am. Had you not asked me, I wouldn't tell you that I'm getting depressed… I am noticing that I am mood swinging and I don't know whether it's my stage of life, and problems which are hormonal, or whether it's depression’...In that situation I did refer her on because I feel that she's been missed...” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia) “The 7A’s tool itself, in working with this client – it let me look at structuring how to work both with … the physical aspects and the emotional responses together. It was really useful.” (Registered nurse, female, diabetes distress) “I really think that part of my practice I need to do more of regularly is start to use the PAID scale and particularly for everyone, not just picking some people but just doing it on everyone, not all the time, but doing it. But, I really think it will actually bring out a lot of things that both sides of the party didn’t realize or think about.” (Nurse practitioner-credentialed diabetes educator, female, diabetes distress) “I can think of a number of people I see where I've recognized fear of hypoglycemia and there's information within that chapter which may help me work through that fear with them.” (Endocrinologist, male, fear of hypoglycemia)
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| Spread the word |
“I actually showed one of my neighbors who is a pharmacist and I was discussing with him, on chapter 5, how good I thought it was to do decisional balancing with someone who is reluctant to start insulin.” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia) “I’ll be actively promoting it as a resource and I’ll be wanting our GPs to have it available to them and I’ll be promoting it heavily.” (Credentialed diabetes educator-registered nurse, female, eating problems) “I’ve talked to my boss and I wouldn’t mind doing a bit of an information session to other dietitians and coaches about it… summarize the importance of dealing with the emotional aspect of diabetes and then point to some of these summary cards and… the handbook.” (Dietitian, female, diabetes distress)
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| Barriers to implementation |
“I think the problem with the psychology referral is that… people with a specific interest in diabetes are few and far between… But, it would be really nice to know which psychologists for instance, in our area, are interested in dealing with patients with diabetes and the same with psychiatrists. I think that’s where I struggle clinically.” (Endocrinologist, male, fear of hypoglycemia) “You know, unless you are lucky enough to have a psychologist that works and is employed within a practice and they don't charge a gap, people can’t afford that.” (Nurse practitioner-credentialed diabetes educator, female, diabetes distress) “Regarding diabetes distress, it's [handbook] encouraging us as health professionals to be able to get on the telephone to follow up, or to arrange all this follow up, but that's not remunerated under Medicare… Under the Medicare system and under the care planning arrangements that we have, I might have one visit allocated, so it doesn't give me necessarily a follow-up visit without the patient then being out of pocket...” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia) “We have 20 minute appointments and have to deal with the medical side of diabetes and then to deal with psychological side too, we probably can designate maybe five minutes – ten minutes, if we’re lucky… we need the numbers and the resources and things at our fingertips… I think it’s fantastic and it definitely is needed but we need to have that information right there or in a website form where we can just go click.” (Endocrinologist, female, fear of hypoglycemia)
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| Suggestions for promotion |
“Getting it out there, is the key… a good advertising campaign, and that's probably best orchestrated through presentation of some of the work in the book at the various diabetes-related clinical meetings that occur around the countryside...” (Endocrinologist, female, fear of hypoglycemia) “I think it needs to go into the Graduate Certificate for Diabetes Education. I think it needs to go to medical students and…pharmacy students as well…” (Credentialed diabetes educator-registered nurse, female, fear of hypoglycemia)
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| Training needs and ideas |
“… actually getting people to physically do the questionnaire themselves or give them a case study scenario so that they’re doing it from the perspective of their person… it’s really important to be familiar with the tool. But, also scoring. So, it’s one thing to give people a questionnaire to fill out but to then be able to score it on the spot and give them some feedback.” (Dietitian, female, diabetes distress) “…as part of the training something along the lines of a mentoring or relationship...you might, as part of the training process, bring along how you do things, case studies, that part of it is meeting and talking with a peer.” (Nurse practitioner-credentialed diabetes educator, female, diabetes distress) “...I think they [chapters] could all be incorporated into one workshop, covering how to ask questions and what to do with the information once you've got it and how to build trust, all that sort of thing.” (Nurse-diabetes educator, female, eating problems) “…practical case studies based. The other thing that works well for medical practitioners is webinars and well, something where people can be at home listening to or do it in their own time or, perhaps type questions in.” (Endocrinologist, female, fear of hypoglycemia) “We need to make the assessment of emotional health a compulsory part of guidelines… because they all tick off these other things on their list. We have to test their cholesterol levels twice a year. We're going to do their HbA1c twice a year… but no one actually asks them about how they are.” (Dietitian, female, eating problems)
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