Improving self-management for diabetes in a Flemish nursing home: An implementation project using the JBI Implementation Framework
Authors: Jespers Hilke , Corremans Marleen 
Published: January 2024

The number of people with type 2 diabetes is increasing, both in our country and internationally. Accurate monitoring is very important. After all, accurate monitoring of blood values can prevent long-term problems such as chronic wounds or eye disease. Involving the patient in monitoring this condition is also recommended by treatment guidelines. Supported self-management improves daily glycemic control. Zorgbedrijf Antwerp, an organisation with home care services, nursing homes and units for assited-living, was looking for good ways to encourage this self-management among caregivers. Both in their home care services and in the residential care centers, Zorgbedrijf experienced insufficient involvement with the elderly to take control of their disease process. Among staff, they notice insufficient attention to education and empowerment for their residents with diabetes.

Several interventions are suggested from the literature to promote self-management in older people with type 2 diabetes. A 2017 systematic review concludes that effective self-management interventions use communication, data provided by the patient, education and feedback.

To put these interventions into practice, several implementation models are available.

The JBI Evidence Implementation Framework (EIF) devotes explicit attention to the methodical application of new up-to-date evidence and, in addition to a step-by-step plan for determining readiness, offers guidance in determining indicators. This ensures sustainable implementation. More than a theoretical framework, this model also includes practical tools for the search for the best available evidence, the interventions to be implemented and the criteria to measure effect. In Belgium, this model has never been used before, but numerous successful projects are available abroad. With funding of Ebpracticenet, a pilot project was set up- to implement self management for diabetes in one nursing home from Zorgbedrijf, using the JBI EIF, guided by the Belgian Interuniversity Collaboration for Evidence-based Practice (BICEP). Important in the Framework is the use of an internal facilitator.  First, this internal facilitator was trained by Bicep to search for evidence and how to use audit and feedback in implementation projects. Clinical leadership is taught to support equity in the stakeholders. In a second phase a multidisciplinary working group was established with all relevant stakeholders. This group was given the mandate to set up criteria and methods for implementation. In this way, clinical engagement is taken into account. Eight criteria were chosen from an evidence summary provided by the JBI database. An in depth context analysis looked revealed additional barriers in structure, culture, communication, resources, leadership, knowledge or attitudes. At present, baseline measurement is finished. Together with the working group, an action plan has been formulated and the kickoff meeting is planned. What we can see already is a project that is driven by a whole team, bottom up. From December to March 2023 , the self-management will start for all eligible new residents. At the ICIC conference, the follow up measurement will show us all relevant results and give us the data for a sustainable follow up of the project.