Project title: Low Intensity mental health Support via Telehealth Enabled Network program (LISTEN)
Time period: November 2021-May 2024
Research lead: Dr Edith Holloway
Funding: MRFF TTRA, Diabetes Australia, Diabetes Victoria, the Australian Diabetes Educators Association
Impact summary
- LISTEN reduced diabetes distress and led to greater improvements in general emotional wellbeing and coping self-efficacy than usual care over the 6-month trial.
- LISTEN also provided broader benefits, such as improvements in diabetes self-management, physical activity, healthy eating habits, health-related quality of life.
- Health economic analyses show that LISTEN is likely to be a cost-effective option for diabetes care.
Fifty per cent of people living with diabetes experience mental health challenges
Living with diabetes places a person at higher risk than the general population of developing a range of physical complications, such as kidney damage and cardiovascular disease (CVD).
Perhaps what is less well known is that a staggering 50 per cent of people living with diabetes also experience mental health challenges, including depression, anxiety and eating disorders. There are also challenges that are specific to living with diabetes such as ‘diabetes distress,’ which is the negative emotional experiences resulting from the daily demands of the condition. It can include feelings of frustration, anxiety, anger, guilt, and burnout.
Diabetes distress can also lead to reduced engagement in all the tasks needed to manage diabetes well, such as taking medications, monitoring glucose when needed, healthy eating habits and physical activity.
Mental health challenges increase the risk of other diabetes complications four-fold, and premature mortality is 50 per cent higher than it is among people without diabetes. People with diabetes are already over-represented in Australia’s hospitals for various reasons, and mental health challenges contribute to increased hospital stays.
A telehealth solution for integrated mental health and diabetes self-management support
The LISTEN program, developed by the research team at the Australian Centre for Behavioural Research in Diabetes (ACBRD) – a partnership between Diabetes Victoria and Deakin University, within the Institute for Health Transformation – was designed to address the mental health aspects of living with diabetes.
LISTEN stands for Low Intensity mental health Support via Telehealth Enabled Network. It is a telehealth solution for integrating mental health and diabetes self-management support.
The LISTEN program uses brief Problem-Solving Therapy – an evidence-based psychological intervention – as a framework for enhancing healthy coping skills. The program is delivered via telehealth and is facilitated by trained diabetes health professionals, such as diabetes educators. Adults with diabetes can access up to four sessions of 45-60 minutes each.
In 2021, the ACBRD research team, led by Dr Edith Holloway and Dr Christel Hendrieckx, secured a $748,484 award through the inaugural round of the Targeted Translation Research Accelerator (TTRA) Research Projects opportunity, and a further $700,000 in partner support (cash and in-kind) from Diabetes Australia, Diabetes Victoria, and the Australian Diabetes Educators Association. The award was delivered by MTPConnect, with support from TTRA Partner, the Australian Centre for Health Services Innovation (AusHSI).
The two-year TTRA funding enabled researchers to run a randomised controlled trial, in which they examined the effectiveness of LISTEN over six months. It sought to determine its feasibility in a real-world setting, its value for money, and its ability to improves mental health outcomes in adults with diabetes.
Program promotes self-help and skills development for people living with diabetes
The TTRA-funded LISTEN project recruited 429 people – 252 women, 172 men and three non-binary – with type 1 and type 2 diabetes. Of those, 216 were randomly allocated to receive the LISTEN intervention. In total, 451 LISTEN sessions were facilitated over the course of the trial. The sessions were delivered by five diabetes health professionals employed by Diabetes Australia, who were trained by the ACBRD researchers in how to deliver the LISTEN program.
The trial evaluated outcomes at eight weeks and again after six months. It showed significant reductions and relief of diabetes distress among people with type 1 and type 2 diabetes who participated in the LISTEN sessions at both eight weeks and at the six-month time-point.
Lead researcher, Dr Edith Holloway, said the trial highlighted the value of the LISTEN program for people living with diabetes: “It’s great to see the benefits immediately after the LISTEN program, but also for these benefits to be maintained six months later is really positive,” she said.
In addition, at eight weeks, people who participated in the LISTEN program recorded a significant increase in their general emotional wellbeing compared to those who received usual care – a level that was maintained at six months.
The research showed not only the clinical value of the program, but also that it was value for money at an average of $262 per person in the context of delivery via Diabetes Australia’s health professionals.
“The cost-utility analysis, led by Professor Cathy Mihalopoulos at Monash University, suggests that the LISTEN intervention may be a cost-effective option that significantly improves a person’s quality of life and is likely to provide value for money for health care decision makers,” Dr Holloway said.
The innovative study also generated evidence to inform clinical and commercial translation of LISTEN into a sustainable service, designed to have immediate and lasting positive impact on the mental health of people with diabetes.
The program held some surprises for the researchers and delivered benefits beyond direct mental health improvements.
For example, participants reported that the LISTEN program increased their engagement in physical activity and healthy eating. It also increased their engagement with diabetes health professionals, as well as their confidence in discussing their needs and preferences with health professionals. In addition, diabetes self-management and glucose monitoring improved.
Paving the way for community-wide access to the telehealth program
The initial success of the trial has led to interest from diabetes organisations and health insurance funds to provide the LISTEN program as a service to their clients and members.
Since the trial finished, Dr Edith Holloway has been successful in being awarded a National Health and Medical Research Council Investigator grant. This recognises Dr Holloway as an Emerging Leader and provides nearly $600,000 in funding to support Dr Holloway’s research program over the next five years. This will enable her to develop an online mental health resource hub for people with diabetes, which will include access to the LISTEN program.
There is also international interest from research groups, such as the DiaBEST group in Norway, who are in discussions about the possibility of training diabetes health professionals in the LISTEN program and providing a referral option to Norwegians who screen positive for diabetes distress.
“In Australia, the LISTEN program has the potential to enhance the lives of more than 700,000 adults living with diabetes who are experiencing mental health challenges, including diabetes distress,” Dr Holloway said. “Our goal is to ensure community-wide access to this important and practical telehealth program.”
Read the LISTEN results paper: Effectiveness of Low Intensity Mental Health Support via a Telehealth Enabled Network (LISTEN) for Adults With Diabetes Distress: A Parallel Group, Pragmatic Randomized Controlled Trial
Research team: Dr Edith Holloway, Dr Christel Hendrieckx, Prof Jane Speight, Prof Timothy Skinner, Jennifer Halliday, Sarah Manallack, Prof Vincent Versace, A/Prof Paul Agius, Prof Adrienne O’Neil, Dr Virginia Hagger, Laura Jenkins, Dr Roslyn Le Gautier, Dr Shikha Gray, Ben Harrap (Deakin University), Prof Cathrine Mihalopoulos and Dr Mary Lou Chatterton (Monash University) and Kim Henshaw (Lived Experience Expert)
Partners and supporters: Collaborative partners on this project are Diabetes Australia, Diabetes Victoria, and the Australian Diabetes Educators Association.
More information: For further information about this project, please email Dr Edith Holloway: eholloway@acbrd.org.au
