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A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time

Dympna Casey1*, Kathy Murphy1, Julia Lawton2, Florence Findlay White3 and Sean Dineen4

Author Affiliations

1 School of Nursing & Midwifery, National University of Ireland, Galway, Ireland

2 Public Health Sciences section, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland

3 Diabetes UK Northern Ireland, Bridgewood House, Newforge Lane Belfast BT9 5NW Northern Ireland

4 Endocrinology and Diabetes Day Centre, University Hospital Galway and Department of Medicine, National University of Ireland, Galway, Ireland

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BMC Public Health 2011, 11:672  doi:10.1186/1471-2458-11-672

Published: 30 August 2011



The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE) DAFNE principles into their daily lives and how these factors change over time.


This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time


Four themes that influenced participants' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation.


Understanding the factors that influence people's ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation.

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Type 1 diabetes; structured education programmes; DAFNE; chronic disease self management; longitudinal qualitative research