This study used the POT developed by Dickoff, James and Wiedenbach’s (1968), and has six elements: Agents, Recipients, Context, Process, Resources, Dynamics and Outcomes. The use of this framework enabled the researcher to develop a diabetes intervention programme, in consideration of the findings of the situational analysis.
Additionally, all components of this theory are operationalized to demonstrate how it fits in the development of the intervention. In this study, the POT directed the development of family-centred nutrition and exercise diabetes care programme based on the outcomes of phase 1.
Figure 2.1: Schematic representation of the application of Practice Orientated Theory
2.13.1 Application of theoretical framework in programme development
As demonstrated by Polit and Beck (2014) theory is “the basic purpose of science since it outperforms the specifics of a particular time, place, and group of people in the relationships among variables”. In this study, Practice Orientated Theory (Dickoff, James & Wiedenbach’s, 1968) is used in the development of family-centred nutrition and exercise diabetes programme, as follows:
2.13.1.1 Agent for performing activity
The agents are individuals who offer the activity. In this study, the agents are researcher and research assistants. Researcher provides overall nutrition and exercise education and demonstration with help of physiotherapists, while research assistants support the researcher.
2.13.1.2 Recipients of the programme
The recipients of the activity receive the prescription of the activity from the agents so as to achieve desired outcomes (Dickoff et al., 1968). Recipients are “the primary beneficiary of the of the intervention”. The primary recipients of this programme are diabetes patients and their family members.
Diabetes patients as recipients
Diabetes patients who get their diabetes treatment at the public clinics are the primary recipients since the programme is aimed at improving their diabetes outcomes, and quality of life.
Family members of diabetes patients as recipients
Family members of diabetes patients are also primary recipient of the programme since the programme is aimed at encouraging effective involvement of family members in diabetes care as for improved diabetes outcomes of patients.
2.13.1.3 Context
Context is defined as “an environment or setting that doesn’t just think about the physical aspects or locality, but policies governing or directing the activity at hand”
(Pfadenhauer, Gerardus, Mozygemba et al., 2017). All factors happening during engagement of the agent with recipient towards yielding desirable outcome could be
included as the context (Meleis, 2012). Therefore, the context for this intervention consists of the locality and scope.
Locality of the programme
The recipients of this programme are diabetes patients receiving diabetes treatment and their families at the clinics of Blouberg Municipality of Capricorn District, Limpopo Province. Therefore, the programme is implemented in the clinics of Blouberg Municipality in the Senwabarwana area.
Scope of the programme
As indicated context is “not only limited to physical location, but also directing activity at hand” (Pfadenhauer et al., 2017), therefore directing activity in this instance is scope of the programme or educational guidelines as well as behavioural change process. A need assessment is required “to enable designing educational programme which deals with local needs of the target population” (Beran, 2015). The scope of the intervention or programme is based on the results of phase 1 of this study.
2.13.1.4 Process
The process emphasises the path, steps or patterns to perform activity. Meleis (2012), regards processes “as steps taken by the agent so as to realize desired goal.
Programme implementation is regarded as the act of applying a programme taking into consideration resources and targeted population” (Michie & Johnston. 2013).
Guidelines are considered as “essential foundations for healthcare policy, planning, delivery, evaluation and quality improvement by clinicians, managers and policy makers” (Gadliard & Alhabib, 2015). Guidelines are sought to translate the complexity of scientific research findings into recommendations that can enhance healthcare quality and outcomes (National academic press, 2013, cited in Galgliard and Alhabib (2015). Implementation guidelines for the intervention are to provide education and practical demonstration. Additional guidelines include:
• To have face to face group talk with participants.
• To use educational tool such posters and pamphlets to facilitate knowledge and behavioural change.
• Arrange with operational managers to use clinic facility or rooms.
• The program will be implemented for a day in a particular clinic and implementation schedule will be drawn and submitted to the clinic 5 days before implementation.
• To recruit diabetes patients at the clinics and requested them to bring family members on the scheduled day.
2.13.1.5 Resources needed
Resources are key in programme implementation. Resources in this context refers to
“equipment’s, financial or human resources which can help with intervention practically on the implementation level and those which will give political support” (Michie &
Johnston. 2013). Therefore, the following resources are needed for the implementation of this programme:
• Facility at the clinic for programme to take place.
• Educational tool (Flyers and wall posters) to use during imparting of knowledge and facilitating behaviour.
• Transportation costs to get patients and family members to and from clinic.
• Light meal for the period of implementation.
• Clinic nurses to help in securing participants and venue.
• Diabetes patients and families as participants or recipient.
2.13.1.6 Dynamics
According to Dickoff et al. (1968), dynamics are “chemical, physical and psychological power sources driving the activity towards the attainment of a goal”. In addition, dynamics are the motivating factors driving the performance of activities towards attainment of desired outcomes. Also, for the programme to achieve its intended outcomes, it requires certain power basis which are motivation, appreciation and empowerment.
Motivation which is defined as “the reason why somebody does something” (Oxford school learner dictionary 2015), serves as the energy source for family-centred diabetes care. Therefore, family members are alerted and motivated to assist diabetes patients, so as to assist themselves since the quantitative survey of the situational analysis revealed that family members are overweight, which implies they are at risk of having diabetes.
Appreciation is regarded “as pleasure that you have when you recognize and enjoy the good qualities of something” (Oxford advanced learner dictionary, 2015). The researcher, as the agent, appreciates family members who are effectively involved in diabetes care starting from consultation and have gained more knowledge, which made them reduce chances of having diabetes. also, diabetes patients who have consulted dietitians and physiotherapist and are engaged in a healthy lifestyle and are not experiencing any diabetes complications.
Empowerment is regarded “as the process by which participation of self and others to decision making” (Booyens & Bezuidenhout, 2017). Empowerment in this context involve the researcher educating and skilling patients and their families on how to change behaviour, adopt a healthy lifestyle in order to improve the quality of life, prevent complications and new diabetes incidences of family members.
2.13.1.7 Outcomes/terminus
Outcome or terminus is regarded “as the desired result of care provided by the health practitioner” (Heslop & Lu, 2014). The Oxford advanced learners dictionary (2015) consider outcome that the situation to be produced at the end of the process or activity which accomplishes a feeling of satisfaction. Moreover, terminus is the ideal outcome to be achieved through the implementation of the family-centred nutrition and exercise diabetes care. Therefore, the outcomes are as follows:
• Increased exercise behaviour.
• Improved healthy eating habits.
• Improved quality of life.
• Stabilized blood glucose levels.
• Effective family involvement in diabetes care starting with consultation with patients.