What Is KALMOD?
KALMOD is a novel holistic decision support system with embedded motivational and psychosocial elements for individuals using mobile health technology, that incorporates enhanced self-management, providing a personal health system deliverable with healthcare professional support in conjunction with routine out-patient consultations. It utilizes reliable, validated and acceptable measures within existing organizational structures of health services provision to focus consultation discussion onto patient identified priorities and enables healthcare professionals to provide collaborative, patient-driven, individualized best practice support in a collaborative and joint goal-setting and co-decision making way. People with diabetes complete a secure, brief questionnaire assessment on an iPad or smartphone that increases individual awareness by identifying their own barriers and priorities for discussion with their HCP. This is then linked via algorithm to all possible care pathways available to meet each individual priority, providing choice of care pathway for discussion with their healthcare professional. This provides personal health systems that facilitates a joint, goal-oriented, person-centred consultation to meet individual needs of each patient. An assessment is made using short validated questionnaires including the short-form Diabetes Empowerment Scale, depression screen, social support questionnaires, diabetes self-care activities questions and abbreviated Problem Areas in Diabetes for personal, social, behavioural and emotional factors, as well as a very brief diabetes-specific health belief scale and disclosure of specific concerns/questions for discussion/answer. Other aspects of care are measured alongside these, including the individual’s current therapy regimen, device options, diabetes education provision and needs, latest HbA1c result, and postcode where country appropriate (to derive a social deprivation scale). Using an algorithm, a pictorial representation of current needs is calculated, along with the identification of potential discussion topics, priorities for behaviour change or therapy modification. This one-page summary provides an easy-to-read, visual snapshot. For the pilot phase, this assessment can be completed in the waiting room at clinic, however, once piloting is complete, it could be completed on any mobile smartphone/tablet device, with the results available for personal self-awareness, action and discussion with HCPs. Screenshots and print-outs can be saved securely/provided to reinforce decision criteria and accompany agreed goals and targets for the individual to act upon, with copies placed on file at clinic for review at the next consultation.
What is new/innovative in KALMOD?
The underpinning Kaleidoscope Model of Care is unique in that it incorporates existing philosophies that address only part of disease care and self-management, and pulls these together into a holistic, wide-reaching model that addresses all aspects of living with diabetes. These factors, whilst not necessarily diabetes-specific, certainly impact on an individual’s ability for optimal self-management. The model incorporates external factors, such as occupational, environmental, lifestyle and social support (or lack thereof), therapies (and devices) and intrinsic personal drivers. These are separated into distinct but linked core components, or ‘cogs’ that interact to reflect individual experience and priorities for their specific treatment needs. It supports healthcare professionals in providing care pathways that are uniquely mapped to an individual’s priorities providing personal health systems. The cogs represent internal and external factors affecting behaviour and present the basis for an individualized care plan of holistic diabetes self-management and support. The assessment is innovative, web-based and securely accessible on mobile devices smartphones and tablets as well as on laptops and desktop computers to provide flexibility for individual users. It is dynamic and particularly innovative due its adaptability, transferability across other health areas.
Why is KALMOD important?
Using KALMOD could help people with T1 diabetes increase awareness of their own personal barriers and facilitators for self-management. Providing predictive personal health systems, individuals are armed to take greater responsibility for their self-management by identifying and understanding their own personal barriers and facilitators in the context of their own lived experience, social and personal circumstances for optimal self-management and quality of life at each visit. As individuals progress through their diabetes journey, they will need and want different combinations of therapy, support and education to fill specific knowledge and support gaps. Regular assessment of these needs will focus the consultation to enable healthcare professionals to provide tailored holistic support. Furthermore, a mechanism whereby individuals feel able to make contact with healthcare professionals, as their circumstances and needs change, ensures the fully responsive nature of this personal health system. KALMOD represents a dynamic, adaptive approach to individual needs at each stage of the diabetes journey and should remove the burden on health-care professionals to provide answers, instead focusing on collaborative healthcare with joint goal-setting, reflection and flexibility. Healthcare professional training is provided in the provision of collaborative care, incorporating the spirit of motivational interviewing and open discovery questioning. To avoid burgeoning public health costs, long-term micro- and macrovascular complications and associated impaired quality of life and functional health status, the optimum management of diabetes is essential. A philosophical shift is required to consider a coherent holistic approach to diabetes care, with the person with diabetes at the heart of decision-making and with availability of therapy, education and support tailored to providing individualized care and behavioural expectations.
For whom is KALMOD beneficial?
KALMOD intervention is beneficial for all individuals with T1 diabetes and for healthcare professionals providing support to those individuals. The intervention will provide the majority of people presenting to their healthcare professional with access to immediate, tailored, evidence-based self-management support and advice to enhance awareness of the impact of behavior change, improve interactions between individuals and healthcare professionals facilitating co-decision making in healthcare, and improve biomedical and quality of life outcomes. For those at low risk of poor prognosis this may be all that is necessary to improve tailored collaborative support. The intervention is usable at different levels of interaction, depending on the personal preferences of the individual and will provide personal health systems that increase user awareness and control over own health management. The intervention will facilitate a supportive, patient-centred environment for specific, tailored support for optimal self-management based on the identified needs, beliefs and priorities of the person with diabetes. The model is not confined to diabetes, rather it could be adapted for other long-term health conditions and it would be our intention to evaluate the model more widely with people with IBD and cancer.
Positioning the Project
Mobile technologies are increasingly employed in various walks of life eg exercise, banking, entertainment and health support. 90% of people have access to smartphone technology and many are increasingly using that technology to find new ways to take control of their own health. Supporting people with chronic conditions poses a significant public health, cost and personal burden. Sub-optimal diabetes control is widespread, with severe consequences both for the individual (long term complications such as retinopathy, neuropathy, micro and macro vascular complications and increased risk of heart attack and stroke) and health systems (additional cost of treating complications, currently 80% of budgets spent on diabetes is spent on treating complications). Despite advances in therapies and healthcare, diabetes prevalence has reached epidemic levels. A paradigm shift away from a purely medical model to a greater emphasis on psychosocial aspects of diabetes has long been advocated. However, little progress has been achieved in supporting optimal diabetes self-management and quality of life. Despite the clinical need for patient-centred services, there remains widespread evidence of poor availability and a lack of training and support for psychosocial care. Helping people with T1 diabetes to understand their personal risk, and the potential benefits of their behavioural actions would facilitate greater self-efficacy, enhanced self-management and improved biomedical and QoL outcomes.