Clinical effectiveness of nursing interventions based on psychosocial constructs in diabetes care: a proposed randomized controlled trial

Comments: An interesting, timely and unusual account of a proposed investigation into locus of control (LC) within the context of diabetes care. There are some shortcomings in the manuscript which need to be addressed by the authors prior to it being recommended for publication. Principally these are: 1. More detail is required on the intervention and in its basis in locus of control and, presumably, social learning theory. 2. Greater explanation and elaboration on the notion that present interventions ‘force’ patients to be LC external, using evidence from the pilot study. 3. Internal LC is increased (in theory) by therapeutic interventions based on social learning theory. LC constraints are not, in fact, applied to practice per sé. 4. The aims of the project on ambiguous and general and inconsistent with the introductory forms on LC. 5. I would think that the independent variable in this study is intervention type, rather than nursing group, since all the dependent variables are patient focused. 6. Should the sample size for this study really be based on HbA? If this study is truly about LC, might the sample size be expected to be based on anticipated differences in Modified Diabetes LC scale scores? 7. Some description of the anticipated statistical analysis would be helpful, ie 2 × 2 ANOVA with repeated measures on the second factor. Attending to the above points should help to give the paper a much sharper focus, this being a critical point for papers which are published on short reports. Dr C. R. Martin Lecturer in Mental Health, University of York This proposed research derives from pilot work conducted by the principal author. Through analysis of variant data using a theoretical framework based on the locus of control construct (Rotter 1966), it appears there could be a key issue for diabetes care, not previously identified in the literature. The intended project is a trial of new nursing interventions using psychosocial constructs as opposed to existing modes of care delivery. It will be conducted in a large inner city area with community nurses in the care of people with type II diabetes. The outcome to patients of the new system will be measured using standard physiological and psychosocial measures validated specifically for diabetes study.