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04 People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, ‘hypos can strike twice’: a mixed methods process evaluation
  1. Despina Laparidou1,
  2. Vanessa Botan1,
  3. Graham R Law1,
  4. Elise Rowan1,
  5. Murray D Smith1,
  6. Amanda Brewster2,
  7. Robert Spaight3,
  8. Keith Spurr2,
  9. Pauline Mountain2,
  10. Sally Dunmore3,
  11. June James4,
  12. Leon Roberts3,
  13. Kamlesh Khunti5,
  14. Aloysius Niroshan Siriwardena1
  1. 1Community and Health Research Unit and Lincoln Clinical Trials Unit, School of Health and Social Care, University of Lincoln, UK
  2. 2Patient and Public Contributor, Lincoln, UK
  3. 3Clinical Audit and Research Unit, East Midlands Ambulance Service NHS Trust, UK
  4. 4University Hospitals of Leicester NHS Trust, UK
  5. 5Leicester Diabetes Centre, University of Leicester, UK


Background Hypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and self-managed if expert support (e.g., education on lifestyle and treatment) is provided. Our aim was to conduct a process evaluation to investigate how ambulance staff and PWD perceived the ‘Hypos can strike twice’ booklet-based ambulance clinician intervention.

Methods We used an explanatory sequential design with a self-administered questionnaire study followed by interviews of PWD and ambulance staff. We followed the Medical Research Council framework for process evaluations of complex interventions to guide data collection and analysis. Following descriptive analysis and exploratory factor analysis, multiple regression models were fitted to identify demographic predictors of overall and subscale scores.

Results 113 ambulance staff members and 46 PWD completed the survey. We conducted interviews with four ambulance staff members and five PWD who had been attended by an ambulance for a hypoglycaemic event. Overall, there were positive attitudes to the intervention from both ambulance staff and PWD. Although the intervention was not always implemented, most staff members and PWD found the booklet informative, easy to read and to use/explain. PWD who completed the survey reported that receiving the booklet reminded and/or encouraged them to test their blood glucose more often, adjust their diet, and have a chat/check up with their diabetes consultant. Interviewed PWD felt that the booklet intervention would be more valuable to less experienced patients or those who cannot manage their diabetes well. Participants felt that the intervention could be beneficial but were uncertain about whether it can prevent a second hypoglycaemic event and/or reduce the number of repeat ambulance attendances.

Conclusions The ‘Hypos may strike twice’ intervention was found to be feasible, acceptable to PWD and staff, prompting reported behaviour change and help-seeking from primary care.

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