ACT now! Improving self-care and emotional wellbeing in people with type 2 diabetes NHS Grampian

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​ACT Now! involved designing and evaluating a guided self-help programme to promote self-management and treat mild to moderate anxiety and depression in adults with type 2 diabetes who are struggling to effectively manage their condition.

In NHS Grampian there are approximately 23,000 people with type 2 diabetes and about 45% do not achieve optimal blood glucose control. Despite good quality education, many still do not change those health behaviours that influence blood glucose levels and health outcomes. Two significant barriers to better diabetes control are anxiety and depression. Treating these using standard methods is successful in improving emotional wellbeing, but does not necessarily lead to better self-management.

Approaches are needed that consider the medical condition, reduce psychological distress, and promote self-management behaviours. A multidisciplinary team in Aberdeen has developed and piloted ‘ACT Now!’ – a web-based, supported, self-help intervention, based on the principles of acceptance and commitment therapy (ACT). ACT Now! consists of five to eight appointments and a similar number of web-based modules. Weekly collaborative goals are set to promote changes in health behaviour and emotional wellbeing.

At the time of the final report, 35 people had been recruited to the intervention. Results show that participants walked significantly further following the programme, and had lower levels of anxiety, depression and diabetes-related distress. Average blood glucose levels (HbA1c) were shown to have reduced by 0.6%. Qualitative interviews showed that participants found ACT Now! to be engaging, acceptable, attractive and helpful.

The project team found that effective engagement with primary care was essential to facilitating recruitment of patients and that there needed to be clear responsibilities within the project team.

Supporting dissemination

This project was given further support through a Spreading Improvement grant to help disseminate learning and maximise the impact of the approach across the health service.

Funding will be used to increase the availability and awareness of Acceptance and Commitment Therapy (ACT) to patients with Type 2 diabetes across Grampian. An enhanced self-referral system will be trialled in routine primary care practices, and an educational outreach approach will be offered to primary care staff to help attain a solid understanding of ACT.

Contact details

For further information about the project, please email Dr Kirsty MacLennan at NHS Grampian.