Health education and perceived patient needs

Patient priorities and needs for diabetes care among urban African American adults

PURPOSE

This study was conducted to determine diabetes care priorities and needs in a group of urban African American adults with type 2 diabetes mellitus.

METHODS

One hundred nineteen African American adults with type 2 diabetes, aged 35 to 75, received behavioral/educational interventions from a nurse case manager, a community health worker, or both. Priorities and needs were assessed during 3 intervention visits.

RESULTS

The most frequently reported priorities for diabetes care were glucose self-monitoring (61%), medication adherence (47%), and healthy eating (36%). The most frequently addressed diabetes needs were glucose self-monitoring and medication adherence. Most of the intervention visits (77%) addressed non-diabetes-related health issues such as cardiovascular disease (36%) and social issues such as family responsibilities (30%).

CONCLUSIONS

Participants' self-reported priorities for diabetes care directly reflected the diabetes needs addressed. Needs beyond the focus of traditional diabetes care (social issues and insurance) are important to address in urban African Americans with type 2 diabetes. Interventions designed to address comprehensive health and social needs should be included in treatment and educational plans for this population.

Can patients set their own educational priorities?

This study aimed to determine if patients can set their own educational priorities accurately and if the impact of diabetes education on knowledge differed between patients who did and did not set their own priorities. Forty patients referred for individual education were randomly assigned to one of two groups. Prior to education with a diabetes specialist nurse (DSN) patients ranked 10 diabetes care topics in order of perceived importance and relevance to their needs and completed a knowledge questionnaire. Group 1 set their own priorities and the DSN directed education according to the patients stated priorities. In Group 2 the DSN set the educational priorities without seeing the patients priority list. The priority ranking by the two groups of the 10 topics and their pre-education knowledge score were not significantly different. Post-education knowledge scores improved equally and significantly in both groups (Group 1 from 23 to 87%; Group 2 from 21 to 79%); P < 0.0001). In both groups, knowledge scores for the top three priorities were significantly higher than for the three lowest ranked topics. Knowledge is neither dependent on, nor a good discriminator of, patient-selected priorities. There may be reasons why it is important for patients to set their own priorities, but education directed solely at those priorities may leave knowledge deficits which could compromise diabetes care.

Diabetes education: whose priorities are met?

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8-month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes-related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p less than 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of 'sick day management' and 'complications', especially favoured by patients, as against 'oral hypoglycaemic agents' and other therapy-related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p less than 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p less than 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p less than 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.