Clinical trial NCT06837428: Peer Comparison-based Risk Communication
Official title: Peer Comparison-based Risk Communication (PRICOM): A Study Protocol to Evaluate the Feasibility of Delivering a Risk Communication Intervention in the Primary Care Setting for Adults With Type 2 Diabetes Mellitus
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes Type 2
Lead sponsor: SingHealth Polyclinics
Sponsor class: OTHER
First posted: 2025-02-20
Enrollment: 40
Sex: ALL
Minimum age (years): 40
Maximum age (years): 79
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The study objective is to evaluate the feasibility of delivering a risk communication intervention, Peer comparison-based Risk Communication (PRICOM), in the primary care setting for adults with poor T2DM control. Findings from the study will inform further revisions to PRICOM and provide an estimated effect size to estimate the required sample size for a multi-site trial.

Detailed description: Background: Younger adults with Type 2 Diabetes Mellitus (T2DM) in Singapore tend to have poorer glycaemic control and medication adherence, factors correlating with high risk of diabetes complications. Late-stage diabetes and its complications are perceived to be slow-progressing and not immediately life-threatening. These reflect a concerning state of diabetes control and risk perception in Singapore. Using the Health Belief Model, a risk communication intervention, Peer comparison-based Risk Communication (PRICOM), was developed for physicians to counsel patients with T2DM supported by a digital tool. PRICOM aims to promote health actions by increasing their risk perceptions of diabetes complications.

Specific aims: The primary aim is to evaluate the feasibility of delivering PRICOM in the primary care setting for adults with poor T2DM control - in terms of recruitment, retention, PRICOM adherence, estimated effect size of score changes in risk perception, health actions and HbA1c change. Secondary aims are to assess validity of the risk perception scale, and to explore patients' perspectives of PRICOM.

Methodology: A multi-site randomised controlled trial will be conducted at a primary care clinic in 2 concurrent phases. In phase 1, content validation and test-retest reliability of a risk perception scale will be carried out. In phase 2, a two-arm randomised controlled trial will be conducted using mixed-methods to evaluate the feasibility of delivering PRICOM. A total 40 patient participants will be recruited by convenience sampling. Eligible patients must be age 40-79 years and have poor T2DM control with at least one HbA1c reading ≥ 8.0% within the last 6 months.

Relevance/significance of the study: Findings from the study will inform further revisions to PRICOM and provide an estimated effect size to estimate the required sample size for a multi-site trial.

Eligibility criteria: Eligibility criteria for patient participation:

* T2DM on follow-up at the respective study site for at least 12 months
* Age 40 to 79 years
* At least one HbA1c reading ≥ 8.0% within the last 6 months
* Able to read and speak English

Exclusion criteria for patient participation:

* Not a Singapore citizen or permanent resident
* Pregnant
* End-stage kidney disease or on renal replacement therapy
* Known terminal illness
* Visual and/or hearing impairment
* Cognitive impairment or mental illness
* Unable to provide informed consent

Primary outcomes:
measure: Risk perception score change
timeFrame: 6 months
measure: Recruitment rate
timeFrame: 6 months
measure: Retention rate
timeFrame: 6 months
Secondary outcomes:
measure: Self-care activity score change
timeFrame: 6 months
measure: Medication adherence score change
timeFrame: 6 months
measure: HbA1c change
timeFrame: 6 months
measure: Perspectives of PRICOM
timeFrame: 6 months
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: SingHealth Polyclinics - Bedok Polyclinic
Study officials:
affiliation: SingHealth Polyclinics
name: Ruiheng Ong
role: PRINCIPAL_INVESTIGATOR
References:
citation: Png ME, Yoong J, Phan TP, Wee HL. Current and future economic burden of diabetes among working-age adults in Asia: conservative estimates for Singapore from 2010-2050. BMC Public Health. 2016 Feb 16;16:153. doi: 10.1186/s12889-016-2827-1.
citation: Roystonn K, Lau JH, AshaRani PV, Siva Kumar FD, Wang P, Sum CF, Lee ES, Chong SA, Subramaniam M. Recognition of diabetes and sociodemographic predictors: results of a cross-sectional nationwide population-based survey in Singapore. BMJ Open. 2022 Mar 1;12(3):e050425. doi: 10.1136/bmjopen-2021-050425.
citation: Quah JH, Liu YP, Luo N, How CH, Tay EG. Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore. BMC Endocr Disord. 2013 Jun 3;13:18. doi: 10.1186/1472-6823-13-18.
citation: Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open. 2017 Sep 14;7(9):e016317. doi: 10.1136/bmjopen-2017-016317.
citation: Tan KW, Dickens BSL, Cook AR. Projected burden of type 2 diabetes mellitus-related complications in Singapore until 2050: a Bayesian evidence synthesis. BMJ Open Diabetes Res Care. 2020 Mar;8(1):e000928. doi: 10.1136/bmjdrc-2019-000928.
citation: Tan JK, Salim NNM, Lim GH, Chia SY, Thumboo J, Bee YM. Trends in diabetes-related complications in Singapore, 2013-2020: A registry-based study. PLoS One. 2022 Oct 11;17(10):e0275920. doi: 10.1371/journal.pone.0275920. eCollection 2022.
citation: Rothman AJ, Kiviniemi MT. Treating people with information: an analysis and review of approaches to communicating health risk information. J Natl Cancer Inst Monogr. 1999;(25):44-51. doi: 10.1093/oxfordjournals.jncimonographs.a024207.
citation: Roach P, Marrero D. A critical dialogue: communicating with type 2 diabetes patients about cardiovascular risk. Vasc Health Risk Manag. 2005;1(4):301-7. doi: 10.2147/vhrm.2005.1.4.301.
citation: Paling J. Strategies to help patients understand risks. BMJ. 2003 Sep 27;327(7417):745-8. doi: 10.1136/bmj.327.7417.745.
citation: Naik G, Ahmed H, Edwards AG. Communicating risk to patients and the public. Br J Gen Pract. 2012 Apr;62(597):213-6. doi: 10.3399/bjgp12X636236. No abstract available.
citation: Gao R, Guo H, Liu Y, Pang Y, Zhang X, Lian X, Yu T, Zhu L, Li F. Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol. BMJ Open. 2022 Jun 28;12(6):e056450. doi: 10.1136/bmjopen-2021-056450.
citation: Garcia-Retamero R, Okan Y, Cokely ET. Using visual aids to improve communication of risks about health: a review. ScientificWorldJournal. 2012;2012:562637. doi: 10.1100/2012/562637. Epub 2012 May 2.
citation: Trevena L. Assessing, communicating, and managing risk in general practice. Br J Gen Pract. 2014 Apr;64(621):166-7. doi: 10.3399/bjgp14X677725. No abstract available.
citation: Welschen LM, Bot SD, Dekker JM, Timmermans DR, van der Weijden T, Nijpels G. The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial. BMC Public Health. 2010 Aug 5;10:457. doi: 10.1186/1471-2458-10-457.
citation: Welschen LM, Bot SD, Kostense PJ, Dekker JM, Timmermans DR, van der Weijden T, Nijpels G. Effects of cardiovascular disease risk communication for patients with type 2 diabetes on risk perception in a randomized controlled trial: the @RISK study. Diabetes Care. 2012 Dec;35(12):2485-92. doi: 10.2337/dc11-2130. Epub 2012 Aug 24.
citation: Rouyard T, Leal J, Baskerville R, Velardo C, Salvi D, Gray A. Nudging people with Type 2 diabetes towards better self-management through personalized risk communication: A pilot randomized controlled trial in primary care. Endocrinol Diabetes Metab. 2018 Jun 22;1(3):e00022. doi: 10.1002/edm2.22. eCollection 2018 Jul.
citation: Mao L, Lu J, Zhang Q, Zhao Y, Chen G, Sun M, Chang F, Li X. Family-based intervention for patients with type 2 diabetes via WeChat in China: protocol for a randomized controlled trial. BMC Public Health. 2019 Apr 5;19(1):381. doi: 10.1186/s12889-019-6702-8.
citation: Feng Y, Zhao Y, Mao L, Gu M, Yuan H, Lu J, Zhang Q, Zhao Q, Li X. The Effectiveness of an eHealth Family-Based Intervention Program in Patients With Uncontrolled Type 2 Diabetes Mellitus (T2DM) in the Community Via WeChat: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2023 Mar 20;11:e40420. doi: 10.2196/40420.
citation: Fang HSA, Tan NC, Tan WY, Oei RW, Lee ML, Hsu W. Patient similarity analytics for explainable clinical risk prediction. BMC Med Inform Decis Mak. 2021 Jul 1;21(1):207. doi: 10.1186/s12911-021-01566-y.
citation: Oei RW, Fang HSA, Tan WY, Hsu W, Lee ML, Tan NC. Using Domain Knowledge and Data-Driven Insights for Patient Similarity Analytics. J Pers Med. 2021 Jul 22;11(8):699. doi: 10.3390/jpm11080699.
citation: Stefanut AM, Vintila M. Psychotherapeutic intervention on breast self-examination based on Health Belief Model. Curr Psychol. 2022 Feb 21:1-9. doi: 10.1007/s12144-022-02871-z. Online ahead of print.
citation: Walrave M, Waeterloos C, Ponnet K. Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach. JMIR Public Health Surveill. 2020 Sep 1;6(3):e20572. doi: 10.2196/20572.
citation: Robinson CA. Trust, Health Care Relationships, and Chronic Illness: A Theoretical Coalescence. Glob Qual Nurs Res. 2016 Aug 12;3:2333393616664823. doi: 10.1177/2333393616664823. eCollection 2016 Jan-Dec.
citation: Gorawara-Bhat R, Huang ES, Chin MH. Communicating with older diabetes patients: self-management and social comparison. Patient Educ Couns. 2008 Sep;72(3):411-7. doi: 10.1016/j.pec.2008.05.011. Epub 2008 Jul 18.
citation: Lim DYZ, Chia SY, Abdul Kadir H, Mohamed Salim NN, Bee YM. Establishment of the SingHealth Diabetes Registry. Clin Epidemiol. 2021 Mar 16;13:215-223. doi: 10.2147/CLEP.S300663. eCollection 2021.
citation: Gibbons FX, Buunk BP. Individual differences in social comparison: development of a scale of social comparison orientation. J Pers Soc Psychol. 1999 Jan;76(1):129-42. doi: 10.1037//0022-3514.76.1.129.
citation: Chan AHY, Horne R, Hankins M, Chisari C. The Medication Adherence Report Scale: A measurement tool for eliciting patients' reports of nonadherence. Br J Clin Pharmacol. 2020 Jul;86(7):1281-1288. doi: 10.1111/bcp.14193. Epub 2020 May 18.
citation: Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000 Jul;23(7):943-50. doi: 10.2337/diacare.23.7.943.