The Process of Developing an Intervention to Increase Awareness of Cardiovascular Risk for Persons With Type 2 Diabetes: Co-Creation Study

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Abstract
Background: Many persons with type 2 diabetes (T2D) lack risk awareness or underestimate their cardiovascular risk. Although health care professionals in primary health care strive to implement risk-awareness strategies for cardiovascular risk, persons with T2D report a lack of meaningful dialogue with health care professionals. Co-creation is grounded in participatory action research and involves participants as equal partners across all stages of a project. This study describes the development of an intervention to increase cardiovascular risk awareness in people with T2D. Objective: This study aims to describe the co-creation process of developing an intervention to increase awareness of cardiovascular risk in persons with T2D. Methods: A co-creative design was used to develop an intervention following a participatory action research framework. Four workshops with persons with T2D, diabetes specialist nurses, and physicians in primary health care explored communication about cardiovascular risk, co-identified needs, co-designed solutions, tested prototypes, and redefined and retested the content of the intervention. The data were analyzed using reflexive thematic analysis. Results: The analysis identified 4 themes: co-define: taking the person’s voice into account; co-design: problem-solving and generating ideas; prototype and test: drafting intervention proposals; and redefine and retest: reviewing suggested interventions. The workshop discussions highlighted the need for new interventions, including a risk assessment tool, a patient handbook, material to prompt reflection, and a web education for specialist diabetes nurses. Conclusions: This study demonstrates the value of co-creation, which was used to develop an intervention to enhance cardiovascular risk awareness in persons with T2D. Diabetes specialist nurses need to explore patients’ perceptions of risk and provide space for emotional responses. The web education is intended to strengthen the person-centered approach of diabetes specialist nurses, the patient handbook encourages reflection and dialogue on personal risk, and the risk assessment tool visualizes individual risk. These components may contribute to increased awareness of cardiovascular risk.

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