Table 1
Inclusion/exclusion criteria.
| INCLUSION CRITERIA | EXCLUSION CRITERIA | |
|---|---|---|
| Population | Adults aged 18 years and above; diagnosis of SMI as defined by any recognised diagnostic criteria and a diagnosis of T2D which had been diagnosed by a physician or confirmed by participant’s medical records. | Children and adolescence (aged below 18); no diagnosis of SMI; studies only involving participants with type 1 diabetes. |
| Interventions | Non-pharmacological integrated interventions evaluating diabetes-related and psychosocial outcomes (e.g., psychological health interventions, physical health interventions, nutritional health interventions, digital health interventions); qualitative studies that explored experiences and views of the intervention. | Non-pharmacological interventions targeting only T2D or only mental health outcomes; pharmacological interventions; preventative interventions to reduce the risk of developing T2D (e.g., diabetes screening; diabetes risk management interventions; weight loss to reduce diabetes risk); diabetes preventive pharmacotherapy. |
| Comparator | Treatment as usual, an alternative non-pharmacological intervention, no intervention (e.g., waitlist control group), and enhanced usual care. | None. |
| Outcomes/phenomena of interest | Primary outcomes include diabetes knowledge, glycaemic control (HbA1c), diabetes self-efficacy, general health (e.g., weight, BMI), psychiatric illness self-management, mental illness symptom severity and quality of life (QoL) measured by validated and standardised measures; experiences and opinions of the intervention. Secondary outcomes include participant attendance, adverse effects of intervention, adverse events experienced (related and not related to the intervention). | Studies that focused on outcomes only related to diabetes and general health outcomes; outcomes only related to mental health; only medication related outcomes (e.g., dose, compliance). |
| Study Design | Interview studies, observational studies, ethnographic studies, randomised controlled trials, randomised and non-randomised trials, prospective studies, pilot studies, feasibility studies, and case series studies. | Pharmacological studies, conference proceedings, research posters, protocols and review articles were excluded. |
Figure 1
PRISMA flow diagram.
Table 2
Summary of study outcomes.
| QUANTITATIVE STUDIES | ||||
|---|---|---|---|---|
| STUDY | PRIMARY OUTCOME MEASURES | RESULTS | SECONDARY OUTCOME MEASURES | FINDINGS |
| Aftab et al., (2018) (1) | Diabetes control | Significant reduction diabetes in control (p = .03) | ||
| General health status | Significant reduction on the mental subscale of the SF-36 from baseline to 60-week follow-up (p = .02) | |||
| Serious mental illness symptoms | No significant reduction in depression or psychopathology | |||
| Functioning | Significant reduction in functioning (p = .037). No significant reduction in disability | |||
| Chwastiak et al., (2018) (2) | Diabetes control | Improved diabetes control from baseline to 3-month follow-up (p = .049) | ||
| BMI | Reduced BMI from baseline to 3-month follow-up (p = .04) | |||
| Serious mental illness symptoms | No significant changes in measures of psychiatric symptoms | |||
| McKibbin et al., (2010) (3) | Diabetes control General health status | No significant change in diabetes control No significant change in BMI | Adverse events | 2 participants did not complete the follow-up assessment due to inpatient hospitalisation |
| Significant reduction on the physical symptoms subscale of the SF-12 from baseline to 16-week follow-up (p = .05). | ||||
| Serious mental illness symptoms | No significant change on the mental health subscale. | |||
| Significant reduction in depression symptoms from baseline to 16-week follow-up (p = .01). No significant change in measures of psychiatric symptom severity Significant improvement in functioning from baseline to 16-week follow-up (p = .01). No significant reduction in disability rating (p = .06) | ||||
| Functioning | ||||
| Sajatovic et al., (2011) (4) | Diabetes control | No significant change in diabetes control | ||
| General health status | No significant change in general health status or BMI | |||
| Serious mental illness symptoms | Significant reduction in depression (p = .01) and psychopathy (p = .01) at 16-week follow-up. No significant change in psychiatric symptom severity | |||
| Functioning | Significant reduction in functioning (p = .01) and no significant reduction in disability (p = .06) | |||
| Sajatovic et al., (2017) (5) | Diabetes control | No significant change in diabetes control | Adverse events | 119 adverse events among 74 participants. Adverse events occurred among 6 peer educators, 30 participants receiving treatment as usual, and 38 TTIM participants. There were three deaths (TTIM, n = 2; treatment as usual, n = 1). |
| General health status | No significant change in general health status or BMI | |||
| Serious mental illness symptoms | Significant reduction in psychopathy (p < 001) and depression (p = .016) from baseline to 60-week follow-up. No significant reduction in psychiatric symptom severity. | |||
| Functioning | No significant reduction in disability ratings. Significant reduction in disability from baseline to 60-week follow-up (p = .003) | |||
| QUALITATIVE STUDIES | ||||
| STUDY | THEMES | FINDINGS | SECONDARY OUTCOMES | FINDINGS |
| Blixen et al., (2014) (6) | Positive group experience | Delivering the intervention increased peer educators’ confidence and created group cohesiveness | ||
| Success with learning the manual | Peer educators had a positive experience learning the training manual content | |||
| Increased knowledge of T2D/SMI | Peer educators developed a greater understanding of their health conditions | |||
| Improved self-management of T2D/SMI | Becoming a peer educator increased awareness of the importance of effective self-management | |||
| Increased self-confidence | Becoming a peer educator increased confidence in knowing their role and supporting group members | |||
| United in purpose | All group members had the same goal | |||
| Lawless et al., (2016) (7) | Disseminating health information | Good attendance from study participants Positive experience delivering the intervention | Participant attendance | 80 (80%) participants attended at least one session, 49 (61%) completed all 12 sessions |
| Facilitating group processes | Nurse educators encouraged the development of a therapeutic environment | Adverse events | Peer educators’ illness severity, participants’ symptoms impacting some group interactions | |
| Minimising logistical barriers | Peer educators used effective modelling strategies Nurse educators used various strategies to overcome logistical barriers encourage attendance | |||
| Coordinating interdisciplinary communication | Nurse educators provided care-linkage to enhance communication between participants’ healthcare providers | |||
[i] Key: BMI = Body Mass Index; TTIM = Targeted Training in Illness Management.
Table 3
Summary of study and participant characteristics.
| AUTHOR, YEAR, COUNTRY | STUDY DESIGN/METHODS, SAMPLE SIZE | LENGTH OF INTERVENTION | LOCATION | PARTICIPANT CHARACTERISTICS | INTERVENTION CHARACTERISTICS |
|---|---|---|---|---|---|
| QUANTITATIVE STUDIES | |||||
| Aftab et al., 2018 (1), USA | Randomised Controlled Trial 200 TTIM group: N = 100 Control group: N = 100 | 60 weeks | Primary care | Anxiety diagnosis group:
No anxiety diagnosis group:
| Targeted Training in Illness Management (TTIM): A group-based psychosocial treatment focusing on psychoeducation, problem identification, goal setting, behavioural modelling, and care linkage. Sessions co-facilitated by a nurse and a peer-educator covers topics on SMI education, diabetes education, problem solving skills, nutrition, physical activity, medication education, medical and social support, and foot care education. TTIM is delivered in a 2-step process:
|
| Chwastiak et al., 2018 (2), USA | Randomized controlled pilot study 35 | The mean duration of the active treatment was 14.8 weeks, with a range of 9 weeks to 27 weeks. The mean number of visits was 4.9 | Community mental health centre |
| Adapted collaborative care (based on TEAMcare model): Initial (60-minute) nurse care manager visit for a health assessment and an individualised health plan, then 30-minute visits for the support of chronic illness self-management (including medication adherence, healthy nutrition, and regular physical activity) every other week for 12 weeks and monthly thereafter for up to six months. Nurses used motivational interviewing and behavioural activation to address barriers to self-management and coordinated multi-agency care. |
| McKibbin et al., 2010 (3), USA | Randomized pre-test, post-test control group design 52 | 24 weeks | In board-and-care and community clubhouse settings | Usual care + information:
Diabetes Awareness Rehabilitation Training (DART)
Other: 14 ± 53.8 | From the paper: Diabetes Awareness Rehabilitation Training (DART) comprised a 24-week intervention with three modules: (1) Basic Diabetes Education; (2) Nutrition; (3) Lifestyle Exercise. Each module contained 4 90-minute manualised sessions. Participants met in groups with 6 to 8 of their peers and one diabetes-trained mental health professional. Concrete behavioural change strategies were used including self-monitoring (e.g., pedometers), modelling, practice (i.e., healthy food sampling), goal setting and reinforcement (i.e., raffle tickets). Simple guidelines were provided such as switching from regular to diet soda and eating slowly. |
| Sajatovic et al., 2011 (4), USA | Prospective, uncontrolled, case-series pilot trial 12 | 16 weeks | Primary care |
| Targeted training in illness management (TTIM) (as previously described). |
| Sajatovic et al., 2017 (5), USA | Randomised controlled trial 200 TTIM group: N = 100 Control group: N = 100 | 60 weeks | Primary care |
| Targeted training in illness management (TTIM) (as previously described). |
| Blixen et al., (2014) (6), USA | Phenomenological 8 peer-educators | Primary care |
| Targeted training in illness management (TTIM) (as previously described). | |
| Lawless et al., (2016) (7), USA | Basic interpretation Missing data | Primary care | Missing data | Targeted training in illness management (TTIM) (as previously described). | |
[i] Key: BMI = Body Mass Index; DART = Diabetes Awareness and Rehabilitation Training; HbA1c = Glycated haemoglobin; T2D = Type 2 diabetes; TTIM = Targeted Training in Illness Management.
Figure 2
Data synthesis of study findings in meta-aggregation.
Table 4
QualSyst Tool for assessment of quality of the included studies.
| QUANTITATIVE STUDIES | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AUTHOR | OBJECTIVE AND STUDY DESIGN (1,2) | PARTICIPANT SELECTION AND CHARACTERISTICS (3,4) | RANDOM ALLOCATION AND BLINDING (5,6,7) | OUTCOME (8) | SAMPLE SIZE (9) | ANALYTICAL METHODS (10,11,12,13) | CONCLUSION SUPPORTED BY RESULTS (14) | TOTAL SUM | TOTAL POSSIBLE SUM | SUMMARY SCORE (%) | LIBERAL THRESHOLD (55 ≤ %) | CONSERVATIVE THRESHOLD (75 ≤ %) |
| Aftab et al., (2018) (1) | 2 | 4 | 0 | 2 | 1 | 3 | 1 | 13 | 22 | 46 | 0 | 0 |
| Chwastiak et al., (2018) (2) | 4 | 3 | 2 | 2 | 2 | 5 | 2 | 19 | 24 | 69 | 1 | 0 |
| McKibbin et al., (2010) (3) | 2 | 3 | 0 | 2 | 1 | 4 | 2 | 15 | 22 | 54 | 0 | 0 |
| Sajatovic et al., (2011) (4) | 4 | 3 | 2 | 2 | 2 | 4 | 2 | 19 | 24 | 69 | 1 | 0 |
| Sajatovic et al., (2017) (5) | 4 | 4 | 2 | 2 | 2 | 3 | 2 | 21 | 28 | 75 | 1 | 1 |
| QUALITATIVE STUDIES | ||||||||||||
| AUTHOR | OBJECTIVE AND STUDY DESIGN (1,2) | FRAMEWORK AND SAMPLING (3,4,5) | DATA COLLECTION AND ANALYSIS (6,7,8) | VERIFICATION AND CONCLUSION (9,10) | TOTAL SUM | TOTAL POSSIBLE SUM | SUMMARY SCORE (%) | LIBERAL THRESHOLD (55 ≤ %) | CONSERVATIVE THRESHOLD (75 ≤ %) | |||
| Blixen et al., (2014) (6) | 4 | 4 | 6 | 2 | 16 | 20 | 80 | 1 | 1 | |||
| Lawless et al., (2016) (7) | 2 | 4 | 1 | 1 | 8 | 20 | 40 | 0 | 0 | |||