{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:34:19Z","timestamp":1777725259177,"version":"3.51.4"},"reference-count":62,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insulin errors in inpatients with diabetes occur frequently during surgical admissions. Older adults have higher risks. There is a need for service user involvement in developing complex interventions to improve insulin safety in hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a logic model for a system\u2010based safety intervention to support safer insulin use for older adults with diabetes undergoing surgical hospital admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A co\u2010design approach combining systems thinking and design thinking methods was employed. Purposive sampling was employed. Older adults with diabetes and multiprofessional staff working across perioperative care were involved as co\u2010designers and decision makers throughout the iterative process of intervention development. An initial exploratory phase included semi\u2010structured interviews with service users (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), hospital staff (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923) and non\u2010participatory observations (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) which informed subsequent collaboration. Initial findings validated in separate service user and staff workshops and engagement activities. The resulting data were presented at joint stakeholder workshops (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) to confirm the final intervention components needed to develop the model. In total,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910 older adults and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911 healthcare professionals working across the perioperative pathway participated in the co\u2010design process between October and December 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Co\u2010designers were engaged and collaborative. Multiple interacting components at patient, staff and context level identified. Through an iterative process, a co\u2010designed logic model known as the SHINE (safe\u2010hospital\u2010insulin\u2010use) wheel was constructed, addressing two prioritised areas:\n                      <jats:italic>transitions of care<\/jats:italic>\n                      and\n                      <jats:italic>right insulin, time and way<\/jats:italic>\n                      . The model also identifies eight actions and twelve separate outputs as components. Solution\u2010related themes centred around:\n                      <jats:italic>it is all so connected; right insulin, right time, right way; safer transitions of care; empowerment; organisation and provision of care; developing and supporting the workforce<\/jats:italic>\n                      . Two prototypes of tools for patient and staff education to support empowerment and increase patient preparedness for hospital admission were developed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multiple interacting components influence hospital insulin safety. System\u2010based, non\u2010linear safety approaches are required. This co\u2010design study identified priorities of older adults with diabetes and healthcare professionals to be addressed in system\u2010wide insulin safety interventions for surgical admissions. Tools developed provide tangible outputs for application in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>People with diabetes with recent lived experience of surgical hospital admission were integrally involved as co\u2010designers and decision makers in this study. They contributed towards interpretation and analysis of findings through discussion, feedback and validation in workshops and through means accessible to them. They were decision makers in the identification of priorities for intervention development and in identifying and validating the content of the toolkit developed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70622","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:06:01Z","timestamp":1772993161000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing an Intervention for Safe Hospital Insulin Use for Older Adults With Diabetes Undergoing Surgical Admission (SHINE Study): A Co\u2010Design Study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8575-9670","authenticated-orcid":false,"given":"Christina","family":"Lange Ferreira","sequence":"first","affiliation":[{"name":"Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery &amp; Palliative Care King's College London  London UK"},{"name":"Diabetes &amp; Endocrinology Wye Valley NHS Trust  Hereford Herefordshire UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hellena","family":"Habte\u2010Asres","sequence":"additional","affiliation":[{"name":"Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery &amp; Palliative Care King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jyothish","family":"Govindan","sequence":"additional","affiliation":[{"name":"Diabetes &amp; Endocrinology Wye Valley NHS Trust  Hereford Herefordshire UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionne","family":"Mytton","sequence":"additional","affiliation":[{"name":"Diabetes &amp; Endocrinology Wye Valley NHS Trust  Hereford Herefordshire UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angus","family":"Forbes","sequence":"additional","affiliation":[{"name":"Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery &amp; Palliative Care King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1725-6040","authenticated-orcid":false,"given":"Kirsty","family":"Winkley","sequence":"additional","affiliation":[{"name":"Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery &amp; Palliative Care King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/DME.13982"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/PDI.1217"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/DME.14209"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12912\u2010022\u201001022\u2010W\/TABLES\/6"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0001006704.88157.20"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq\u20102017\u2010000312"},{"key":"e_1_2_12_8_1","unstructured":"G.RaymanandP.KarDiabetes GIRFT Programme National Specialty Report.2020 accessed March 24 2025 https:\/\/gettingitrightfirsttime.co.uk\/wp\u2010content\/uploads\/2020\/11\/GIRFT\u2010diabetes\u2010report.pdf."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119697473.ch39"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0B013E31827B6BBC"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/DC10\u20100304"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16247"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.111062"},{"key":"e_1_2_12_14_1","unstructured":"The National Confidential Enquiry into Patient Outcomes and Death. 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