Evaluation of the quality and contents of diabetes mellitus patient education on Internet

Effects of mind mapping based on standardized patient program in patient education among postgraduate nursing students in clinical setting

BACKGROUND

Patient education as an important process of postgraduate nursing education, however in previous studies there was limited study focus on the improvement of nursing students' patient education in clinical practice.This study examined the effects of a mind mapping based on standardized patient program in the patient education knowledge and communication competence of postgraduate nursing students in clinical setting.

METHODS

The present quasi-experimental study was performed in 2022 on 74 postgraduate nursing students who had taken clinical practice courses at affiliated hospital of Zunyi Medical University. Students were underwent two weeks of mind mapping based on standardized patient program. The outcome measures were patient education knowledge and communication competence evaluated were by the self-designed questionnaire consisting of 6 questions based on the Likert scale and nurse-patient communication competency rating scale respectively, self-efficacy was evaluated by the general self-efficacy scale, and patients' satisfaction were measured using a self-designed question. Data collection was conducted before and after intervention. Data analysis was performed using SPSS 19.0 software, and descriptive statistics and inferential statistics were performed.

RESULTS

Significant improvements in patient education knowledge, patient education communication competence, and self-efficacy (all P = 0.000)were observed after intervention. Improvements were also seen in measures of patients' satisfaction; 12/74 (16.22%) patients reported satisfied at baseline but only 53/74 (71.62%) at the end of intervention.

CONCLUSIONS

A web-based mind maps integrated with standardized patient program could improve patient education knowledge, communication competence,and self-efficacy of postgraduate nursing students in clinical setting.

Design and Development of Tools for Risk Evaluation of Diabetes and Cardiovascular Disease in Community Pharmacy

There is an increasing motivation to implement pharmacist-led screening services in community pharmacies. This study aims to develop tools to support the pharmacist in the context of a diabetes and cardiovascular disease risk assessment service. Our development involved a multistep process using a user-centred approach, including a need assessment phase (14 patients, 17 pharmacists) and a creative design phase, followed by the evaluation of the materials (10 patients, 16 pharmacists). Three following themes covering educational needs emerged from stakeholders' discussions: "content", "layout", and "form", with three additional themes regarding the practical organisation: "software", "awareness", and "referral". Based on the need assessment, tools for patient education purposes and awareness campaigns were created. During the development, special attention was paid to the writing style and structure with less text and more graphical colourful elements to suit patients with different health literacy and educational levels. The evaluation phase allowed researchers to observe participants engaging with the materials. Overall, participants were satisfied with the tools. The contents were considered valuable and relevant. However, adaptations were necessary to ensure their understanding and long-term usability. Finally, future research is required to evaluate the materials' impact on patients' behaviour towards their identified risk factors and ensure their effectiveness.

When intents to educate can misinform: Inadvertent paltering through violations of communicative norms

Paltering is a form of deception whereby true statements are used to mislead and is widely employed in negotiations, marketing, espionage, and ordinary communications where speakers hold ulterior motives. We argue that paltering is accomplished through strategic violations of communicative norms such as the Gricean cooperative principles of relevance, quantity, quality and manner. We further argue that, just as genuine paltering deceives by deliberately violating communicative norms, inadvertent violations of these norms may be just as misleading. In this work, we demonstrated that educational information presented prominently on the American Diabetes Association website violated the Gricean communicative principles and disrupted readers' performance on a test of diabetes knowledge. To establish the effects of these communicative violations, we revised the ADA's information to preserve the original content while better adhering to pragmatic principles. When these ADA explanations were judiciously revised to minimize pragmatic violations, they were transformed from misleading to educational.

"Some say no, some say yes": Receiving inconsistent or insufficient information from healthcare professionals and consequences for diabetes self-management: A qualitative study in patients with Type 2 Diabetes

AIMS

To explore the information-seeking experiences of patients with Type 2 diabetes and how these influenced self-management behaviours.

METHODS

We interviewed 18 patients with Type 2 Diabetes attending outpatient diabetes centers in South Western Sydney. Data were analyzed thematically.

RESULTS

Patients described a number of challenges they faced when seeking information about diabetes self-management. One major challenge was receiving inconsistent and insufficient information from healthcare professionals, which consequently undermined patients' ability to self-manage diabetes. This became a disincentive in carrying out self-management tasks, and led to confusion and mistrust regarding the veracity of information received. Participants also described finding reliable information, and difficulty understanding and accessing relevant information as challenges. Medical jargon and lack of comprehensive explanations exacerbated knowledge deficits compounded by the complex maze of internet resources that some patients accessed. In response to what they perceived as confusing or inconsistent information, some patients followed "their own way" of managing their diabetes.

CONCLUSIONS

Inconsistent information not tailored to the needs of patients adversely affects self-management. Taking time to provide simple explanations and assisting patients in navigating reliable web resources is becoming a vital role of healthcare professionals to reduce knowledge gaps in patients with low health literacy.

Readability and Quality of Online Information on Osteoarthritis: An Objective Analysis With Historic Comparison

Background

Osteoarthritis (OA) is the most common cause of disability in people older than 65 years. Readability of online OA information has never been assessed. A 2003 study found the quality of online OA information to be poor.

Objective

The aim of this study was to review the readability and quality of current online information regarding OA.

Methods

The term osteoarthritis was searched across the three most popular English language search engines. The first 25 pages from each search engine were analyzed. Duplicate pages, websites featuring paid advertisements, inaccessible pages (behind a pay wall, not available for geographical reasons), and nontext pages were excluded. Readability was measured using Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Website quality was scored using the Journal of the American Medical Association (JAMA) benchmark criteria and the DISCERN criteria. Presence or absence of the Health On the Net Foundation Code of Conduct (HONcode) certification, age of content, content producer, and author characteristics were noted.

Results

A total of 37 unique websites were found suitable for analysis. Readability varied by assessment tool from 8th to 12th grade level. This compares with the recommended 7th to 8th grade level. Of the 37, 1 (2.7%) website met all 4 JAMA criteria. Mean DISCERN quality of information for OA websites was “fair,” compared with the “poor” grading of a 2003 study. HONcode-endorsed websites (43%, 16/37) were of a statistically significant higher quality.

Conclusions

Readability of online health information for OA was either equal to or more difficult than the recommended level.

Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service

Background

The prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined.

Objective

The objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features.

Methods

The study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy.

Results

Mobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m²) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively).

Conclusions

The overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques.

Evaluation of the Informational Content, Readability and Comprehensibility of Online Health Information on Monogenic Diabetes

The purpose of this study was to assess the informational content, readability, suitability and comprehensibility of websites offering educational information about monogenic diabetes available to patients. The top 20 results from 15 queries in four search engines were screened. Content analysis was performed by two independent coders. Readability was determined using Flesch-Kincaid grade level (FKGL) and Simplified Measure of Goobledygook (SMOG). The Comprehensibility Assessment of Materials (SAM + CAM) scale was utilized to evaluate website suitability and comprehensibility. Only 2% (N = 29) of 1200 screened websites met inclusion criteria. Content analysis showed that 16 websites presented information on at least the most common forms of MODY (1, 2 and 3), four addressed the utility of genetic counseling, and none included support resources for patients. All websites exceeded the consensus readability level (6th grade) as assessed by FKGL (10.1 grade) and SMOG (12.8 ± 1.5 grades). Although the majority (N = 20) of websites had an overall "adequate" to "superior" quality score (SAM + CAM score > = 40%), more than one-third scored "not suitable" in categories of content, literacy demand, graphics, and learning motivation. The online educational resources for monogenic diabetes have a high readability level and require improvement in ease of use and comprehensibility for patients with diabetes.

The Quality of Online Health-Related Information – an Emergent Consumer Health Issue

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.

The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.

Online Patient Education for Chronic Disease Management: Consumer Perspectives

Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.

Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content

Background

Internet websites and smartphone apps have become a popular resource to guide parents in their children’s feeding and nutrition. Given the diverse range of websites and apps on infant feeding, the quality of information in these resources should be assessed to identify whether consumers have access to credible and reliable information.

Objective

This systematic analysis provides perspectives on the information available about infant feeding on websites and smartphone apps.

Methods

A systematic analysis was conducted to assess the quality, comprehensibility, suitability, and readability of websites and apps on infant feeding using a developed tool. Google and Bing were used to search for websites from Australia, while the App Store for iOS and Google Play for Android were used to search for apps. Specified key words including baby feeding, breast feeding, formula feeding and introducing solids were used to assess websites and apps addressing feeding advice. Criteria for assessing the accuracy of the content were developed using the Australian Infant Feeding Guidelines.

Results

A total of 600 websites and 2884 apps were screened, and 44 websites and 46 apps met the selection criteria and were analyzed. Most of the websites (26/44) and apps (43/46) were noncommercial, some websites (10/44) and 1 app were commercial and there were 8 government websites; 2 apps had university endorsement. The majority of the websites and apps were rated poor quality. There were two websites that had 100% coverage of information compared to those rated as fair or poor that had low coverage. Two-thirds of the websites (65%) and almost half of the apps (47%) had a readability level above the 8th grade level.

Conclusions

The findings of this unique analysis highlight the potential for website and app developers to merge user requirements with evidence-based content to ensure that information on infant feeding is of high quality. There are currently no apps available to consumers that address a variety of infant feeding topics. To keep up with the rapid turnover of the evolving technology, health professionals need to consider developing an app that will provide consumers with a credible and reliable source of information about infant feeding, using quality assessment tools and evidence-based content.

Iranian nurses and nursing students' attitudes on barriers and facilitators to patient education: a survey study

The aim of this study is to describe the attitudes of Iranian nurses and students on barriers and facilitators to patient education. In this descriptive quantitative study, 103 nurses and 84 nursing students in two teaching hospitals in an urban area of Iran responded to a questionnaire investigating their attitudes on patient education. Results showed that all nurses and the majority (87.3%) of the students mentioned that they performed patient education. Moreover, 95% and 63.3% of the nurses and students respectively accepted that patient education was one of their roles. The nurses stated that heavy workload, inadequate time and lack of educational facilities were main barriers to patient education. The students believed that lack of knowledge, lack of communication skills and heavy workload were main barriers to patient education from their perspectives. While Iranian nurses and nursing students had positive attitudes towards patient education, it could not guarantee the implementation of patient education. Therefore, the clarification of patient education activities and development of a patient education team with the support of healthcare settings' administrators can facilitate the process of patient education in the Iranian healthcare settings.

Information and decision support needs in patients with type 2 diabetes

Diabetes and its sequelae cause a growing burden of morbidity and mortality. For many patients living with diabetes, the Internet is an important source of health information and support. In the course of the development of an Interactive Health Communication Application, combining evidence-based information with behavior change and decision support, we assessed the characteristics, information, and decision support needs of patients with type 2 diabetes.The needs assessment was performed in two steps. First, we conducted semi-structured interviews with 10 patients and seven physicians. In the second step, we developed a self-assessment questionnaire based on the results of the interviews and administered it to a new and larger sample of diabetes patients (N = 178). The questionnaire comprised four main sections: (1) Internet use and Internet experience, (2) diabetes knowledge, (3) relevant decisions and decision preferences, and (4) online health information needs. Descriptive data analyses were performed.In the questionnaire study, the patient sample was heterogeneous in terms of age, time since diagnosis, and glycemic control. (1) Most participants (61.7%) have searched the web for health information at least once. The majority (62%) of those who have used the web use it at least once per month. (2) Diabetes knowledge was scarce: Only a small percentage (1.9%) of the respondents answered all items of the knowledge questionnaire correctly. (3) The most relevant treatment decisions concerned glycemic control, oral medication, and acute complications. The most difficult treatment decision was whether to start insulin treatment. Of the respondents, 69.4 percent thought that medical decisions should be made by them and their doctor together. (4) The most important information needs concerned sequelae of diabetes, blood glucose control, and basic diabetes information.The Internet seems to be a feasible way to reach people with type 2 diabetes. The heterogeneity of the sample, especially with respect to diabetes knowledge, makes it clear that the projected Interactive Health Communication Application should tailor the content to the individual user, taking account of individual characteristics and preferences. A wide range of topics should be covered. Special attention should be paid to the advantages and disadvantages of insulin treatment and the fears and hopes associated with it. These results were taken into account when developing the Interactive Health Communication Application that is currently being evaluated in a randomized controlled trial (International Clinical Trials Registry DRKS00003322).

Quality of online information on type 2 diabetes: a cross-sectional study

Evidence-based health information is a prerequisite for patients with type 2 diabetes to engage in self-management and to make informed medical decisions. The Internet is an important source of health information. In the present study, we systematically assessed formal quality, quality of decision support and usability of German and English language websites on type 2 diabetes. The search term 'type 2 diabetes' was entered in the two most popular search engines. Descriptive data on website quality are presented. Additionally, associations between website quality and affiliation (commercial vs. non-commercial), presence of the HON code quality seal and website traffic were explored. Forty-six websites were included. Most websites provided basic information necessary for decision-making, while only one website also provided decision support. Websites with a HON code had significantly better formal quality than websites without HON code. We found a highly significant correlation between usability and website traffic and a significant correlation between formal quality and website traffic. Most websites do not provide sufficient information to support patients in medical decision-making. Our finding that usability and website traffic are tightly associated is consistent with previous research indicating that design is the most important cue for users assessing website credibility.

Health information, behavior change, and decision support for patients with type 2 diabetes: development of a tailored, preference-sensitive health communication application

PURPOSE

Patient involvement in diabetes treatment such as shared decision-making and patient self-management has significant effects on clinical parameters. As a prerequisite for active involvement, patients need to be informed in an adequate and preference-sensitive way. Interactive Health Communication Applications (IHCAs) that combine web-based health information for patients with additional support offer the opportunity to reach great numbers of patients at low cost and provide them with high-quality information and support at the time, place, and learning speed they prefer. Still, web-based interventions often suffer from high attrition. Tailoring the intervention to patients' needs and preferences might reduce attrition and should thereby increase effectiveness. The purpose of this study was to develop a tailored IHCA offering evidence-based, preference-sensitive content and treatment decision support to patients with type 2 diabetes. The content was developed based on a needs assessment and two evidence-based treatment guidelines. The delivery format is a dialogue-based, tunneled design tailoring the content and tone of the dialogue to relevant patient characteristics (health literacy, attitudes toward self-care, and psychological barriers to insulin treatment). Both content and tailoring were revised by an interdisciplinary advisory committee.

CONCLUSION

The World Wide Web holds great potential for patient information and self-management interventions. With the development and evaluation of a tailored IHCA, we complement face-to-face consultations of patients with their health care practitioners and make them more efficient and satisfying for both sides. Effects of the application are currently being tested within a randomized controlled trial.

The impact of electronic education on metabolic control indicators in patients with diabetes who need insulin: a randomised clinical control trial

AIMS AND OBJECTIVES

To determine the impact of electronic education on metabolic control indicators in patients with diabetes who were insulin dependent.

BACKGROUND

Education can play an important role in controlling diabetes. Electronic (web-based, telehealth) education may be an efficient way to improve the patients' ability to control this disease.

DESIGN

Randomised clinical control study.

METHODS

The participants in this clinical study were 48 insulin-dependent patients referred to diabetes centres in Shiraz, Iran. Serum concentrations of haemoglobin A(1C) , fasting blood sugar, triglycerides and high-density and low-density lipoprotein cholesterol were measured. Then the participants were divided randomly into control and experimental groups (n = 24). Participants in the experimental group received a specially designed electronic education programme for twelve weeks. The main components of the programme were a consultation service, quick answers to patients' questions, contact with the healthcare team and educational materials. At the end of the intervention period, all serum values were measured again in both groups. The data were compared using spss v 13·5 software.

RESULTS

Serum concentrations of haemoglobin A(1C) (p < 0·001) and low-density lipoprotein cholesterol (p < 0·002) were significantly lower in the intervention group.

CONCLUSION

The electronic education programme was useful in lowering two metabolic indicators of diabetes.

RELEVANCE TO CLINICAL PRACTICE

Electronic education can be associated with increased health and patient satisfaction, and can eliminate the need to train personnel.

Assessing the quality, suitability and readability of internet-based health information about warfarin for patients

BACKGROUND

Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet.

METHOD

Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites.

RESULTS

The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an 'adequate' score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an 'adequate' score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less).

CONCLUSION

Despite the overall 'adequate' quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills.

Systematic review and evaluation of web-accessible tools for management of diabetes and related cardiovascular risk factors by patients and healthcare providers

Objective

To identify and evaluate the effectiveness, clinical usefulness, sustainability, and usability of web-compatible diabetes-related tools.

Data sources

Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, world wide web.

Study selection

Studies were included if they described an electronic audiovisual tool used as a means to educate patients, care givers, or clinicians about diabetes management and assessed a psychological, behavioral, or clinical outcome.

Data extraction

Study abstraction and evaluation for clinical usefulness, sustainability, and usability were performed by two independent reviewers.

Results

Of 12616 citations and 1541 full-text articles reviewed, 57 studies met inclusion criteria. Forty studies used experimental designs (25 randomized controlled trials, one controlled clinical trial, 14 before–after studies), and 17 used observational designs. Methodological quality and ratings for clinical usefulness and sustainability were variable, and there was a high prevalence of usability errors. Tools showed moderate but inconsistent effects on a variety of psychological and clinical outcomes including HbA1c and weight. Meta-regression of adequately reported studies (12 studies, 2731 participants) demonstrated that, although the interventions studied resulted in positive outcomes, this was not moderated by clinical usefulness nor usability.

Limitation

This review is limited by the number of accessible tools, exclusion of tools for mobile devices, study quality, and the use of non-validated scales.

Conclusion

Few tools were identified that met our criteria for effectiveness, usefulness, sustainability, and usability. Priority areas include identifying strategies to minimize website attrition and enabling patients and clinicians to make informed decisions about website choice by encouraging reporting of website quality indicators.

Online physical activity information: will typical users find quality information?

This study evaluated physical activity Web sites to determine quality, accuracy, and consistency with principles of the extended parallel process model (EPPM). Three keyword searches were conducted using 4 search engines to find a sample of N = 41 Web sites. Three raters evaluated the Web sites using the JAMA benchmarks to assess quality and American College of Sports Medicine and Centers for Disease Control and Prevention recommendations for physical activity to determine accuracy, as well as checking for inclusion of EPPM variables. Data were analyzed using descriptive statistics and analysis of variance with least squares means. Only 22% of the sites were high quality, none were highly accurate, and most were consistent with the EPPM. Quality ratings were weakly associated with accuracy. Educational and .net sites were rated significantly higher in quality and accuracy, and government sites were most consistent with the EPPM. Quality Web sites were more often found by using Yahoo and Google. "Exercise" yielded more accurate results, whereas "physical activity" and "fitness" produced more Web sites consistent with the EPPM. It is encouraging that most sites incorporated EPPM concepts; however, quality and accuracy were poor, leaving physical activity information seekers at risk for disease and injury.

Análise da informação sobre a leishmaniose visceral disponível em portais brasileiros da rede mundial de computadores: internet

Com o objetivo de analisar a adequação da informação sobre leishmaniose visceral disponível em portais brasileiros, realizou-se através de portal de busca, levantamento, seleção e análise do conteúdo das páginas eletrônicas. Foram identificadas 24 páginas com objetivos informativos, sendo oito governamentais, 10 comerciais e seis classificadas como outros. Utilizando-se um formulário, foram avaliados os conteúdos relativos à transmissão, reservatório, controle e doença, contendo tópicos considerados essenciais. Os manuais normativos do Ministério da Saúde e a literatura científica foram definidos como padrões de informação. Observou-se, em todas as páginas, elevados percentuais de ausência de informações referentes aos tópicos discriminados em cada um dos quatro blocos de conteúdos. A análise de adequação das informações, quando estas estavam presentes, mostrou 100% de adequação nas páginas governamentais e outros. Entretanto, nas páginas comerciais foram elevados os percentuais de informações incorretas ou incompletas, principalmente no bloco doença. De modo geral, o conteúdo sobre a leishmaniose visceral nas páginas eletrônicas analisadas foi considerado pouco informativo.

Educational program for diabetic patients in Korea--multidisplinary intensive management

The socioeconomic burden of type 2 diabetes and its complications has become a big social issue in Korea. And so, the proper management of diabetes in terms of its prevention and management of complications are considered the most important tasks in our healthcare system and these can be accomplished through the multidisciplinary program. Our program is composed of separate educational programs for in-patients and out-patients, individualized teaching, and group teaching. In order to maintain such a program, there need systemic interactions among the team members, including endocrinologists, nurses, dieticians, pharmacists, and social workers. The optimal way to control diabetes can be achieved through interactions between members of the diabetes management team and the patient. For the patient, this is expected to lead to a better glycemic control, prevention of diabetes complications, and sparing of medical expenses as well. As for the healthcare providers, physicians are able to treat their patients more efficiently. Thus, both the patient and the healthcare centers can benefit from this multidisciplinary educational program. Diabetes educational program should be a basis for the management of diabetes.

The Internet and the diabetic foot: quality of online information in French language

The Internet has become a major source of health information for consumers. Nevertheless the quality of medical information varies widely and is generally poor.

AIM

This study aimed to evaluate the quality of information delivered on French-speaking Internet about the diabetic foot.

METHODS

Websites were selected using three popular search engines and introducing "foot+diabetes" and "foot+diabetic" as keywords. Two diabetologists independently evaluated the quality of information using a specially created scoring grid (range 0-52) based on acknowledged and published criteria with items relevant to general characteristics of the site and to information content. One hundred and twenty websites were selected but only 27 were included for analysis.

RESULTS

Agreement between the two raters was close for global score and site content but lower for site characteristics. Averaged global score ranged from 8 to 44. Only five sites were assessed as very advisable with a score higher than 39; in contrast 18 sites were judged as not advisable at all (score lower than 26).

CONCLUSION

This study, the first to be devoted to information about the diabetic foot on the Internet, clearly shows the variability and the general poor quality of information delivered by the great majority of French-speaking websites. Regulation organisms are urgently needed for checking and labelling public oriented health information in order to make the Internet a performing tool for patient information.

Type 2 diabetes and inheritance: what information do diabetes organizations provide on the Internet?

AIMS

The worldwide epidemic of Type 2 diabetes necessitates preventive actions. Providing information to high-risk populations is key. In an international comparison of websites, we aimed to investigate the presence and quality of information provided by diabetes organizations on inheritance of Type 2 diabetes and the benefits of a healthy lifestyle targeted at those with a family history or belonging to a specific ethnic population.

METHODS

All websites included in the International Diabetes Federation member list in English, German, French, Dutch, Spanish, Portuguese, Swedish, Norwegian, Finnish, Danish and Japanese were included for assessment. Using qualitative content analysis, we reviewed 34 websites which provided health-related information on diabetes.

RESULTS

Most websites mention family history as a risk factor. However, an explanation of the interaction of lifestyle factors and increased genetic susceptibility is lacking. Ethnicity is mentioned in only half of the sites describing risk factors. Although most websites do provide information on the importance of a healthy lifestyle, they do not address specific high-risk groups. Only two websites encourage Type 2 diabetic patients to inform family members of the familial character of diabetes.

CONCLUSIONS

Information on inheritance of Type 2 diabetes and prevention specifically targeted at high-risk groups on the Internet by diabetes organizations is often of poor quality or indeed is lacking. Efforts should be made to disseminate information on heredity of Type 2 diabetes and preventive options to the general public and high-risk populations.

Development and evaluation of a patient-oriented education system for diabetes management

PURPOSE

To develop and evaluate a Web-based, patient-orientated diabetic education management (POEM) system.

METHODS

The POEM system has been developed to extend hospital patient education by integrating patients' medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives for patients to continuously and persistently log in and learn the required knowledge and skills, improving their clinical outcomes. A quasi-experimental method that uses control groups and pretests was used to evaluate the outcomes of the system intervention. We recruited patients with type-2 diabetes and alternatively assigned them to intervention and control groups. We compared laboratory test results including fasting blood glucose, HbA1c, total cholesterol, triglyceride (TG), and HDL between the two groups from the first visit through each follow-up visit. The study period progressed from September 2003 to May 2004 at the Metabolism Center of a medical teaching hospital in Taipei.

RESULTS

In this study, we recruited 274 participants: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. The patients' laboratory test results from the first visit for fasting blood glucose, HbA1c, total cholesterol level, TG, and HDL in the intervention and control groups were respectively 187.54+/-77.10 and 189.99+/-73.49 mg/dl, 9.03 +/- 2.79% and 8.95 +/- 2.23%, 193.29 +/- 47.93 and 202.52 +/- 58.45 mg/dl, 152.48 +/- 70.85 and 157.37 +/- 74.88 mg/dl, and 44.97 +/- 12.09 and 45.32 +/- 12.08 mg/dl. There were three follow-up visits during the study period. We collected laboratory test results of the two groups through each of the following visits and analyzed them using ANCOVA. We discovered a significant difference in fasting blood glucose levels between intervention and control group as early as the first follow-up. At the second follow-up, both fasting blood glucose and HBA1c levels were significantly different between intervention and control group. At the third follow-up, there was a significant difference in fasting blood glucose, HBA1c, and total cholesterol between intervention and control group. We also monitored the number of logins for the patients in the intervention group during the follow-up period. The result showed the patients had consistently logged into the POEM system (about 8.5 +/- 3.7 logins per person per month after 3 months enrollment). Thus, the patients in the intervention group had better control of their fasting blood glucose, HbA1c and total cholesterol levels than those in the control group due to the assistance of the system.

CONCLUSIONS

The POEM system can help patients control their glucose, HbA1c and total cholesterol levels to manage their diabetes, providing an easy and inexpensive way to extend hospital-based patient education services for community-based continuous patient education.

British internet-derived patient information on diabetes mellitus: is it readable?

BACKGROUND

Sizeable proportions of Western populations have limited language and math skills, making it difficult for them to fully and safely understand and act upon online health information.

METHODS

We used the Flesch Reading Ease and Flesch-Kincaid Grade Level formulae to test the readability of 20 representative Web documents from 15 trustworthy sites/providers of British origin, providing consumer information on diabetes mellitus.

RESULTS

The corresponding average and median U.K. reading ages of the tested material were found to be 14.2 and 14.65 years of age, respectively (range, 11-16.9 years). The most readable pages in our study (about one-third of all tested pages) had a Flesch Reading Ease score above 60 (range, 60.4-73.3) and a Flesch-Kincaid Grade Level of 8.0 or lower (range, 6.0-8.0), corresponding to a U.K. reading age of 11-13 years. These readability levels are well above the estimated reading age of the U.K. population in general (9 years).

CONCLUSIONS

These results point to a chronic and often forgotten information quality problem. Though quick and easy to use, and certainly better than nothing, readability formulae are not without their limitations. These should be recognised, and any health information quality benchmarking checklist in use should be supplemented with some testing for content readability (e.g., suitable readability formulae as a bare minimum and, if possible, feedback from a panel of readability experts and representative lay reviewers). Online health information providers need to ensure that their written material is pitched at a level appropriate to their intended lay audience. Providers should also consider other means of delivering health education and promotion programmes, so that no one is left behind.