Assessment of group versus individual diabetes education: a randomized study

Interdisciplinary interventions that improve patient-reported outcomes in perioperative cancer care: A systematic review of randomized control trials

INTRODUCTION

Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer.

METHODS

We searched PubMed, EMBASE, and CINAHL for randomized control trials published at any time and screened 7,195 articles. To be included in our review, studies needed to report patient-reported outcomes, have interventions that occur in the perioperative period, include surgical cancer treatment, and include at least one non physician intervention clinical team member: advanced practice providers, including nurse practitioners and physician assistants, clinical nurse specialists, and registered nurses. We narratively synthesized intervention components, specifically roles assumed by intervention clinical team members and interdisciplinary team processes, to compare interventions that improved patient-reported outcomes, based on minimal clinically important difference and statistical significance.

RESULTS

We included 34 studies with a total of 4,722 participants, of which 31 reported a clinically meaningful improvement in at least one patient-reported outcome. No included studies had an overall high risk of bias. The common clinical team member roles featured patient education regarding diagnosis, treatment, coping, and pain/symptom management as well as postoperative follow up regarding problems after surgery, resource dissemination, and care planning. Other intervention components included six or more months of continuous clinical team member contact with the patient and involvement of the patient's caregiver.

CONCLUSIONS

Future interventions might prioritize supporting clinical team members roles to include patient education, caregiver engagement, and clinical follow-up.

Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review

BACKGROUND

This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis.

METHODS

Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used.

RESULTS

Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures.

DISCUSSION

There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.

Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes

BACKGROUND

There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations.

OBJECTIVES

To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care.

SEARCH METHODS

We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section.

SELECTION CRITERIA

We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy.

DATA COLLECTION AND ANALYSIS

We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors.  Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available.

MAIN RESULTS

We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted.  Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three.  Combinations of the three most effective QI strategies were estimated to lead to the below effects:  - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%;  - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg;  - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other).

AUTHORS' CONCLUSIONS

There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.

Qualitative assessment of family caregiver-centered neonatal education program in Karnataka, India

Globally 2.5 million newborns die every year before they reach the age of one month; the majority of these deaths occur in low- and middle-income countries. Among other factors, inadequate knowledge and skills to take care of newborns contribute to these deaths. To fill this gap, training patients and family members on the behaviors needed to improve essential newborn care practices at home is a promising opportunity. One program that aims to do this is the Care Companion Program (CCP) which provides in-hospital, skills-based training on care of mothers and newborns to families. This study uses semi-structured interviews to understand how and why knowledge and behaviors of maternal and newborn care behaviors change (or don't change) as a result of CCP sessions and participants' perception of the impact of CCP on change. Interviews focused on knowledge and behaviors around key neonatal and newborn topics and health seeking behaviors for health complications. Forty-two in-depth interviews were conducted among families with recently-delivered babies at their homes from four districts in Karnataka, India. Respondents have a positive perception about CCP, found training useful and appreciated other family members presence during the training. CCP increased knowledge and awareness and provided critical details to key behaviors like breastfeeding. Respondents were more likely to be receptive toward details on already known topics, like hand washing before touching the baby. Awareness increased on newly learned behaviors, like skin-to-skin care, which don't conflict with cultural norms. The CCP did not influence nonrestrictive maternal diet as much, which cultural norms heavily influence. In-hospital family caregiver education programs, like CCP, can positively influence key neonatal behaviors by imparting knowledge and key skills. However, the effect is not universal across health behaviors.

Educational preferences in individuals with cardiometabolic disease differs with age, ethnicity and educational status

OBJECTIVES

To evaluate how sociodemographic factors influence educational modality preferences in people with cardiometabolic disease.

METHODS

This was a cross-sectional study performed in people with diabetes and cardiovascular disease, who completed a questionnaire to denote their previous experience and ranked preferences for different educational modalities.

RESULTS

The questionnaire was completed by 3751 people, of whom 59% were men, median (interquartile range) age was 68 (59-76) years, and 78% were White European. In total, 73% had diabetes, 35% had heart disease, and 10% had history of stroke; the majority (83.4%) had one of these conditions. Overall preference was for one-to-one education (77% ranked first choice), and telephone education ranked the lowest. People tended to prefer modalities they had previously experienced.

CONCLUSIONS

We highlight the importance of considering factors that could influence selection of educational modalities including age, ethnicity, gender and educational level. We anticipate this approach will aid in the design, delivery and tailoring of educational programmes that are accessible to the diverse cohort of people living with chronic diseases, including diabetes and cardiovascular disease.

PRACTICE IMPLICATIONS

Given the influence of multiple demographic factors and previous experiences on expressed preferences, providers should support individuals to make informed decisions about educational interventions to maximise engagement.

Effectiveness-implementation trial comparing a family model of diabetes self-management education and support with a standard model

BACKGROUND

Diabetes self-management education and support (DSMES) is an effective approach for improving diabetes self-care behaviors to achieve improved glycemic management and other health outcomes. Engaging family members may improve outcomes, both for the person with diabetes (PWD) and for the family members. However, family models of DSMES have been inconsistently defined and delivered. We operationalize Family-DSMES to be generalizable and replicable, detail our protocol for a comparative effectiveness trial comparing Standard-DSMES with Family-DSMES on outcomes for PWDs and family members, and detail our mixed-methods implementation evaluation plan.

METHODS

We will examine Family-DSMES relative to Standard-DSMES using a Hybrid Type 1 effectiveness-implementation design. Participants are ≥18 years old with type 2 diabetes mellitus and hemoglobin A1c ≥7.0%, recruited from rural and urban primary care clinics that are part of an academic medical center. Each participant invites a family member. Dyads are randomly assigned to Family- or Standard-DSMES, delivered in a small-group format via telehealth. Data are collected at baseline, immediately post-intervention, and 6-, 12-, and 18-months post-intervention. Outcomes include PWDs' hemoglobin A1c (primary), other biometric, behavioral, and psychosocial outcomes (secondary), and family members' diabetes-related distress, involvement in the PWD's diabetes management, self-efficacy for providing support, and biometric outcomes (exploratory). Our mixed-methods implementation evaluation will include process data collected during the trial and stakeholder interviews guided by the Consolidated Framework for Implementation Research.

CONCLUSION

Results will fill knowledge gaps about which type of DSMES may be most effective and guide Family-DSMES implementation efforts.

REGISTRATION

The trial is pre-registered at clinicaltrials.gov (#NCT04334109).

Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study

BACKGROUND

Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators.

METHODS

This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale.

RESULTS

The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05).

CONCLUSIONS

Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary.

A Telehealth Diabetes Intervention for Rural Populations: Protocol for a Randomized Controlled Trial

Background

Diabetes self-management education and support (DSMES) is a crucial component of diabetes care associated with improved clinical, psychosocial, and behavioral outcomes. The American Association of Diabetes Care and Education Specialists, the American Diabetes Association, and the American Academy of Family Physicians all recommend DSMES yet accessing linguistically and culturally appropriate DSMES is challenging in rural areas. The Diabetes One-Day (D1D) program is an established DSMES group intervention that has not been adapted or evaluated in rural communities.

Objective

The specific aims of this paper are (1) to adapt the existing D1D program for use in rural communities, called rural D1D (R-D1D); and (2) to conduct a patient-level randomized controlled trial to examine the effects of R-D1D and standard patient education, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

Methods

This is a protocol for a pilot type II hybrid implementation-effectiveness trial of a culturally adapted virtual DSMES program for rural populations, R-D1D. We will use Boot Camp Translation, a process grounded in the principles of community-based participatory research, to adapt an existing DSMES program for rural populations, in both English and Spanish. Participants at 2 rural primary care clinics (4 cohorts of N=16 plus care partners, 2 in English and 2 in Spanish) will be randomized to the intervention or standard education control. The evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Patient-level effectiveness outcomes (hemoglobin A_1c, diabetes distress, and diabetes self-care behaviors) will be assessed using patient-reported outcomes measures and a home A_1c test kit. Practice-level and patient-level acceptability and feasibility will be assessed using surveys and interviews.

Results

This study is supported by the National Institute of Nursing. The study procedures were approved, and the adaptation processes have been completed. Recruitment and enrollment started in July 2021.

Conclusions

To our knowledge, this will be the first study to evaluate both effectiveness and implementation outcomes for virtually delivered DSMES, culturally adapted for rural populations. This research has implications for delivery to other rural locations where access to specialty diabetes care is limited.

Trial Registration

ClinicalTrials.gov NCT04600622; https://clinicaltrials.gov/ct2/show/NCT04600622

International Registered Report Identifier (IRRID)

DERR1-10.2196/34255

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

Self-management in patients with type 2 diabetes: Group-based versus individual education. A systematic review with meta-analysis of randomized trails

AIM

Patient education is an essential component of the treatment of type 2 diabetes mellitus (T2DM). The present meta-analysis was aimed at verifying the efficacy of group-based versus individual education for self-management in patients with T2DM.

DATA SYNTHESIS

A Medline and Embase search up to January 1st, 2021, was performed, including Randomized Controlled Trials (RCT) with duration>6 months, enrolling patients with T2DM and comparing individual-based with group-based educational programs. The primary outcome was endpoint HbA1c; secondary endpoints were lipid profile, body weight, blood pressure, patients' adherence/knowledge, and quality of life. The weighed difference in means (WMD) and Mantel-Haenzel Odds Ratio (MH-OR), with 95% Confidence Interval (CI), were calculated. We retrieved 14 RCT. No significant between-group difference in HbA1c (WMD -0.39[-0.89; 0.09] mmol/mol, p = 0.11) was observed. At metaregression analyses, longer trial duration, higher baseline mean age and duration of diabetes, and lower baseline HbA1c were correlated with greater efficacy of group-based programs in reducing HbA1c. When analyzed separately, trials excluding insulin-treated patients showed a significant reduction of HbA1c in favor of group education.

CONCLUSIONS

In patients with T2DM, group education has similar efficacy as individual education on glucose control. Group programs are associated with an improved quality of life and patients' knowledge.

PROSPERO AND OSF REGISTRATION

ID243149.

Effect of educational interventions on knowledge of the disease and glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Globally, type 2 diabetes has continued to increase, now accounting for over 90% of all diabetes cases. Though the magnitude of uncontrolled glycaemic levels in patients with type 2 diabetes is steadily rising, evidence showed that effectively controlled glycaemic levels can prevent complications and improve the quality of life of these patients. As little is known about the effect of educational interventions on this population, this systematic review and meta-analysis evaluated the effectiveness of educational interventions versus standard care on glycaemic control and disease knowledge among patients with type 2 diabetes.

METHODS

PubMed, Google Scholar, Cochrane Library, Scopus, African Journals Online and Wiley Online Library were searched. Two authors independently assessed within-trial risk of bias in each included study using revised Cochrane risk-of-bias tool for randomised trials. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 19 trials with 2708 study participants were included in the review. Primary outcomes (glycaemic control) were reported in 18 trials. The pooled estimated impact of educational intervention on glycaemic levels using the random-effects model was -0.83 (95% CI: -1.17 to -0.49, p<0.001). Subgroup analyses revealed greater A1c reductions in those studies with intervention duration of up to 3 months and with empirical intervention designs. Educational interventions led to significant increases in participants' knowledge of type 2 diabetes (standardised mean difference: 1.16; 95% CI: 0.71 to 1.60; I2=93%).

CONCLUSION

In the current review overall, educational interventions can potentially lead to improved glycaemic control levels in patients with type 2 diabetes despite heterogeneity across the studies. Besides, the findings showed that educational interventions could increase disease knowledge among patients with type 2 diabetes.

PROSPERO REGISTRATION NUMBER

CRD42020205838.

Hispanic Caregivers' experience of pediatric type 1 diabetes: A qualitative study

OBJECTIVE

It is widely recognized that Type 1 Diabetes (T1D) outcomes are worse among Hispanic children; however, little is published about the perspectives of these patients and their caregivers. Our intent was to characterize the lived experience of Hispanic caregivers of children with T1D, focusing on the role of language and culture and their perspectives on current medical care and alternative care models. We studied Hispanic caregivers of patients (age 2-17 years) with T1D of greater than 6 months' duration.

RESEARCH DESIGN AND METHODS

We completed semi-structured interviews and focus-groups of a purposive sample of 20 members of our population of interest. We developed a codebook and completed multidisciplinary consensus coding, then conducted iterative thematic analysis using qualitative software and discussion to generate themes.

RESULTS

We gathered data from 20 Hispanic caregivers of T1D patients (11.37 ± 3.00 years old, 4.80 ± 2.84 years since diagnosis). 85% of caregivers were female, 80% preferred Spanish, and 15% were college-educated. Our analysis yielded 4 themes across the participants: (1) Culturally-based nutrition challenges, (2) Social isolation and lack of support for T1D care, (3) Hesitancy to fully embrace diabetes technology, and (4) Deferential views of care experience and providers. Overarching all of these themes was support for Hispanic group-based models of care tailored to address these concerns.

CONCLUSIONS

The unique concerns among Hispanic caregivers of children with T1D suggest the importance of culturally tailored interventions to improve care. With successful implementation, such interventions could diminish widening disparities in healthcare outcomes.

Factors influencing the effective management of diabetes during humanitarian crises in low- and middle-income countries: a systematic review

OBJECTIVES

The management of non-communicable chronic diseases such as diabetes mellitus is often poor in humanitarian crisis settings. Poor disease management can have serious long-term consequences. This review sought to identify studies that explored the effectiveness of interventions and the determinants that may improve the management of diabetes in the humanitarian context.

STUDY DESIGN

A systematic review was conducted of all types of studies that implemented diabetes programmes in humanitarian settings.

METHODS

MEDLINE, Embase, CINAHL and Web of Science were searched for relevant articles using multiple search terms for relevant studies published in English between 2000 and June 2020. Quality assessments using valid tools, were conducted. A narrative synthesis of the findings was then performed.

RESULTS

The search yielded 550 citations. After de-duplicating and screening, 19 studies were eligible for inclusion. Most studies were conducted in the Middle East (74%), Asia (16%) and Africa (10%). The interventions reported to improved diabetes care included the mHealth tool, intensive lifestyle intervention, task-shifting, psychosocial support, distribution of glucometers and comprehensive care. Insufficient drug supply, out-of-pocket cost, the complexity of insulin therapy and low adherence to guidelines were identified as barriers.

CONCLUSION

There is a paucity of evidence on optimal diabetes care in acute crisis and natural disaster settings. The review was constrained by the low quality of the studies included. Nevertheless, it is likely that mHealth can be feasibly utilised, as educational SMS messages are cost-effective and electronic medical records can enhance disease monitoring. In addition, a multidisciplinary approach to care improves glycaemic control and is desirable due to the multifaceted nature of the disease and management required. Several key barriers have been identified that need to be tackled. Overall, the evidence base for diabetes care in humanitarian settings remains sparse, and further research is needed.

Effectiveness and economic impact of a diabetes education program among adults with type 2 diabetes in South Texas

BACKGROUND

The long-term growth and sustained high prevalence of obesity in the US is likely to increase the burden of Type 2 diabetes. Hispanic individuals are particularly burdened by a larger share of diabetes than non-Hispanic White individuals. Given the existing health disparities facing this population, we aimed to examine the effectiveness and potential cost savings of the Diabetes Education Program (DEP) offered as part of Healthy South Texas, a state-legislated initiative to reduce health disparities in 27 counties in South Texas with a high proportion of Hispanic adults.

METHODS

DEP is an 8-h interactive workshop taught in English and Spanish. After the workshop, participants receive quarterly biometric screenings and continuing education with a health educator for one year. Data were analyzed from 3859 DEP participants with Type 2 diabetes living in South Texas at five time points (baseline, 3-months, 6-months, 9-months, 12-months). The primary outcome variable of interest for study analyses was A1c. A series of independent sample t-tests and linear mixed-model regression analyses were used to identify changes over time. Two methods were then applied to estimate healthcare costs savings associated with A1c reductions among participants.

RESULTS

The majority of participants were ages 45-64 years (58%), female (60%), Hispanic (66%), and had a high school education or less (75%). At baseline, the average hemoglobin A1c was 8.57%. The most substantial reductions in hemoglobin A1c were identified from baseline to 3-month follow-up (P < 0.001); however, the reduction in A1c remained significant from baseline to 12-month follow-up (P < 0.001). The healthcare cost savings associated with improved A1c for the program was estimated to be between $5.3 to $5.6 million over a two to three year period.

CONCLUSION

Findings support the effectiveness of DEP with ongoing follow-up for sustained diabetes risk management. While such interventions foster clinical-community collaboration and can improve patient adherence to recommended lifestyle behaviors, opportunities exist to complement DEP with other resources and services to enhance program benefits. Policy makers and other key stakeholders can assess the lessons learned in this effort to tailor and expand similar initiatives to potentially at-risk populations.

TRIAL REGISTRATION

This community-based intervention is not considered a trial by ICMJE definitions, and has not be registered as such.

Amankwah J. Diabetes self-management education interventions in the WHO African Region: A scoping review

INTRODUCTION

Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region.

MATERIALS AND METHODS

The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis.

RESULTS

Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption.

CONCLUSIONS

The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

The Effect of Diabetes Self-Management Education on Glycemic Control in Minority Patients With Diabetes Mellitus

Background Diabetes self-management education (DSME) plays a vital role in diabetes control yet is highly underutilized, especially in the minority population. The efficacy of DSME on glycemic control among the Hispanic and non-Hispanic black population is not as well established as it is compared to the non-Hispanic White population. Methodology In this retrospective cohort study, patients who participated in both group and one-to-one DSME classes at Saint Francis Medical Center, Trenton, New Jersey, from 2017 to 2019 were identified. Mean hemoglobin A1c levels before DSME and after DSME were compared using paired t-test. Results A total of 344 patients were included in the study. Out of 344 patients, 200 (58%) patients were Hispanic and 97 (28%) were non-Hispanic black, 42 (12%) were Caucasian, and five (2%) were from other races. The mean hemoglobin A1c was reduced by an average of 1.08% among patients who participated in group DSME (DSME done in group settings) and by an average of 1.95% among patients who participated in one-to-one DSME (DSME done in individualized settings). Conclusion  DSME is effective in reducing hemoglobin A1c levels in Hispanic and non-Hispanic black majority patients. One-to-one DSME is more effective than group DSME in reducing hemoglobin A1c in this patient population.

The Effect of Peer Support on Knowledge and Self-Efficacy in Weight Management: A Prospective Clinical Trial in a Mental Health Setting

Metabolic disturbances commonly occur with serious mental illness (SMI). Strategies for weight management include group education, peer support, and follow up. This study evaluated the effects of group peer support on body weight, Confidence and Conviction (C&C), diet quality and health-related quality of life in a mental health setting. Fourteen participants [aged 51.7 + /- 12.2 years; four male ten female] who were unable to achieve and maintain 5% weight loss were recruited from a metabolic clinic at a mental health care facility. Weight, C&C, Dietary Screener Questionnaire (DSQ), and 36-item Short Form Survey Instrument (SF-36) were collected at baseline, 3, 6, and 12 months. SF-36 showed significant improvement in Vitality/Energy (-3.823, p = 0.003) and General Health Perception (-2.919, p = 0.014) at 3 months, significant decrease in Physical Functioning (-2.391, p = 0.048) and significant improvement in Pain (-2.885, p = 0.023) from baseline to 12 months. DSQ showed an inverse association between C&C and sugar intake.

Encouraging foot care in people with and without diabetes through narrative communication

In order to minimize risk of infection and potential foot complications, it is recommended that people with and without diabetes check their feet regularly for problems such as cuts, sores, blisters or calluses. Hence, an understanding of how to craft effective messages to encourage people to check their feet is important. Two studies investigated the use of narrative stories to encourage foot problem detection behaviour; Study 1 in a general population sample (N = 193), and Study 2 in a sample of people with type 1 or type 2 diabetes (N = 129). In both studies participants were randomised to either (a) receive an information sheet written in first-person narrative; (b) the same in non-narrative format; or (c) no information sheet. Changes in weekly detection behaviour was the outcome of interest. In both studies, greater detection behaviour was observed in the narrative message condition vs. non-narrative condition and the non-narrative condition vs. no information condition. Our findings have implications for the design of health messages in delivering effective foot care education to people with and without diabetes, suggesting that narrative information sheets may be more effective than non-narrative information sheets.

The effect of structured diabetes self-management education on type 2 diabetes patients attending a Primary Health Center in Kuwait

AIM

To evaluate the impact of diabetes self-management education (DSME) on diabetes control measured by glycated hemoglobin (HbA1c) in nationals and expatriates with type 2 diabetes mellitus (T2DM) in Kuwait.

METHOD

A total of 291 patients with T2DM (intervention = 150, control = 141) were assessed in a single-center, controlled study to compare the impact of DSME sessions on HbA1c levels as a measure of metabolic control of diabetes mellitus. Measurements of HbA1c were taken at baseline, 6-months, and 12-months. Multiple explorative association tests and regression models were constructed to examine the intervention effects.

RESULTS

Patients that received DSME sessions demonstrated better diabetes control with an average reduction of 1.3% (14 mmol/mol) HbA1c over 12-months compared to an average HbA1c increase of 1.1% (12 mmol/mol) in the control group (p < 0.001). Using pairwise comparisons, young, male, and expatriate patients and patients with HbA1c above 7% demonstrated the highest improvements in HbA1c with DSME sessions. In multivariate regressions, DSME intervention was associated with a 1.7% (18 mmol/mol) HbA1c reduction indicating better control of diabetes (p < 0.001).

CONCLUSION

DSME sessions were associated with better glycemic control in patients with T2DM over 12 months. This study establishes the effectiveness of DSME sessions for both Kuwaiti nationals and expatriates, which represent a significant portion of the population in Kuwait and the Arabian Gulf region. The favorable impact of DSME suggests a promising cost-effective approach to reduce the risk of complication associationed with diabetes suitable for the unique demographic characteristics in the region.

Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review

BACKGROUND

Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals.

METHODS

Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity.

RESULTS

The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed.

CONCLUSION

Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.

Mandarin multidimensional health literacy questionnaire for patient supporting groups: A quality improvement article

A patient support group (PSG) can serve the purposes of group therapy and education. However, how to evaluate outcome which can feedback to improve the PSG remains unclear. Health literacy, which is associated with patient outcome, has not been used in the evaluation of PSG.Since 2017, we had conducted a working group dedicated to the creation and improvement of PSG. We applied a questionnaire (Mandarin Multidimensional Health Literacy Questionnaire, MMHLQ) for PSGs of all kinds of diseases (5 types, 8 diseases). The outcome was evaluated by the MMHLQ (5 dimensions, 20 variables). We determined factors (age, 1st-time/non-1st-time participation, and patient/family participation) that were associated with all 20 health literacy.We finally obtained 458 questionnaires, with a response rate as high as 91.1% in 8 PSGs. Participants were 55.30 ± 16.39 y/o. The highest score was with the dimension of understanding (12.25 ± 1.85) and the lowest score was with the dimension of appraisal (10.66 ± 2.33). Participating patients (compared to family) were associated with a higher score with "obey the instruction of medical personnel to care disease" but lower score with "find health information from the network". Moreover, older participants (age ≥65 years) had lower scores for all questions in MMHLQ, within which the dimension of appraisal received the lowest scores (P < .001).We found that the highest score is with the dimension of understanding, and the lowest score with the dimension of appraisal. The elderly participants showed lower abilities in health literacy, especially with the dimension of the appraisal. Results from MMHLQ can be used to adjust the PSG curriculum to improve the health literacy of participants.

Quality Improvement Initiatives in Reforming Patient Support Groups-Three-Year Outcomes

BACKGROUND

Little has been done regarding the research on quality and quantity of patient support groups (PSGs) and how they can be improved. Here, we present three-year experiences of a quality improvement (QI) program of our PSGs.

METHODS

We launched earlier on a three-year project to improve our PSGs, including the number and quality of curricula. Data were collected on the number of PSGs, curricula, and participants.

RESULTS

In the first year, we organized relevant resources of our hospital and established a standard protocol for applying financial support and reporting the results. In the second year, we elected "the best patient" to promote sense of honor and better peer supports. In the third year, we surveyed through questionnaires participants' health literacy to improve their feedback. Competitions and exhibitions of achievements were held each year to share results of every PSG. Finally, we had increased the volume of participation of patients and family over these three years (3968, 5401 (+35.5%) and 5963 (+50.3%)). Participation of staff also increased significantly (489 and 551 (+12.7%)). Furthermore, more interdisciplinary curricula were generated, with fewer doctors (38.2% to 29%), but greater numbers of the following: nurses (4.9% to 17.4%), nurse practitioners (0.4% to 14.5%), medical laboratory scientists (2.5% to 16.3%), social workers (4.7% to 41.7%), and teachers from outside (0% to 1.8%).

CONCLUSION

In this first study on QI efforts on PSGs, we enlisted a core change team, drew a stakeholder map, and selected an improvement framework with good results.

Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review

BACKGROUND

Schizophrenia spectrum disorders impact functioning, reduce quality of life and increase the risk of physical illness and premature mortality. Nutritional intervention studies aimed at decreasing body weight have demonstrated efficacy in improving metabolic outcomes; however, few studies have explored the impact of interventions designed to modify diet on mental health outcomes.

AIM

To synthesize the existing experimental studies of adjunctive diet modification as an intervention in the treatment of psychotic disorders, analyze findings related to effectiveness and safety, highlight knowledge gaps and limitations, and set forward recommendations for future research studies.

METHODS

An extensive a priori search strategy was developed and the databases Embase, Embase Classic, Ovid MEDLINE were searched. Screening and data extraction were completed in duplicate. Studies included in this analysis were experimental studies of an adjunctive dietary intervention (overall dietary pattern or education on dietary change) for treatment of schizophrenia spectrum disorders. No restrictions were placed on control groups or blinding. The studies were required to report a mental health outcome.

RESULTS

Twenty-five clinical trials were identified, along with two additional protocols and two meta-analyses. Nineteen of the clinical trials reported improvement in one or more mental health domain including psychosis symptoms, cognition, and quality of life. A high level of heterogeneity was found with respect to patient population, intervention, and study design. All of the studies included lifestyle or psychosocial components in addition to dietary modification. The nutrition advice provided to participants was poorly described overall and compliance was not assessed. The studies that showed benefit tended to have a smaller sample size and were less likely to be randomized but were more likely to use a group delivery intervention.

CONCLUSION

Further research assessing effectiveness and efficacy of clearly reported dietary interventions is warranted, especially those using rigorous methodology, modifying diet in isolation and assessing participant compliance.

Health Literacy Varies According to Different Background Disease Natures and Characteristics of Participants for Patient Support Groups

Introduction: Patient support groups (PSGs) should be designed according to the backgrounds of participants and the nature of their diseases. Using health literacy as an outcome indicator for PSGs is rare. Methods: All questionnaires (Mandarin Multidimensional Health Literacy Questionnaire, MMHLQ) were collected from eight PSGs to evaluate the health literacy of participants. Background data of participants were also collected, including patient or family, age, and first-time participation or not. Results: A total of 458 questionnaires were collected from eight PSGs. The diseases were: autoimmune disease (systemic lupus nephritis (SLE), malignancy (head and neck cancer (HNC), chronic disease (diabetes mellitus or DM), chronic kidney disease (CKD), hemodialysis and chronic obstructive pulmonary disease (COPD), genetic disease (autosomal dominant polycystic kidney disease (ADPKD), and degenerative disease (osteoporosis). For vasculitis (42.21 ± 16.49 years old for SLE) and genetic disease (48.95 ± 17.58 years old for ADPKD), participants were younger. More significant differences between first-time participation and MMHLQ scores were found in disease of osteoporosis, CKD, COPD, and hemodialysis. More significant differences between role of participation (patients themselves or family) and MMHLQ scores were found in SLE, ADPKD, hemodialysis, and CKD. More significant differences between age (elderly or not) and MMHLQ score were found in HNC, DM, CKD, COPD, and osteoporosis. Conclusion: Background data of participants varied across different diseases. Different disease natures and patient background statuses should therefore demand different designs in PSG. MMHLQ before PSGs can be used to help to improve the PSG curriculum on the health literacy of patients.

A qualitative exploration of cardiovascular disease patients' views and experiences with an eHealth cardiac rehabilitation intervention: The PATHway Project

The aim of this study is to explore participants’ views and experiences of an eHealth phase 3 cardiac rehabilitation (CR) intervention: Physical Activity Towards Health (PATHway). Sixty participants took part in the PATHway intervention. Debriefs were conducted after the six-month intervention. All interviews were audio recorded and transcribed verbatim. Transcripts were analysed with Braun and Clarke’s thematic analysis. Forty-four (71%) debriefs were conducted (n = 34 male, mean (SD) age 61 (10) years). Five key themes were identified: (1) Feedback on the components of the PATHway system, (2) Motivation, (3) Barriers to using PATHway, (4) Enablers to using PATHway, and (5) Post programme reflection. There were a number of subthemes within each theme, for example motivation explores participants motivation to take part in PATHway and participants motivation to sustain engagement with PATHway throughout the intervention period. Participant engagement with the components of the PATHway system was variable. Future research should focus on optimising participant familiarisation with eHealth systems and employ an iterative approach to development and evaluation.

A systematic review of nudge theories and strategies used to influence adult health behaviour and outcome in diabetes management

BACKGROUND

Diabetes is a chronic disease associated with a variety of complications, and nudging may be a potential solution to improve diabetes control. Since nudging is a new concept, no review of literature on nudging diabetic patients into improving their health behaviour has been done. Therefore, we aim to collate a list of nudge intervention and determine the context in which nudging is successful.

METHODS

We adopted a two-arm search strategy comprising the search of literature databases and snowballing using relevant search terms. We summarized patient characteristics, the nudge intervention, according to nudging strategies, delivery mode and their outcomes. The conditions present in effective nudge interventions were assessed and reported.

RESULTS

We retrieved 11,494 studies from our searches and included 33. An additional five studies were added through snowballing. Studies included utilized framing (n=5), reminders (n=10), gamification (n=2), social modelling (n=5) and social influence (n=16). Studies on reminders and gamification were more likely to have a statistically significant outcome. The targeted health behaviours identified were medication adherence, physical activity, diet, blood glucose monitoring, foot care, self-efficacy, HbA1c and quality of life. Of these, studies with adherence to medication, foot care practice and quality of life as targeted health behaviours were more likely to show a statistically significant outcome.

CONCLUSION

Nudging has shown potential in changing health behaviour of patients with diabetes in specific context. We identified two possible factors (delivery mode and patient characteristics) that may affect the effectiveness of nudge intervention.

Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting

AIMS

To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes.

METHODS

A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors.

RESULTS

Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%).

CONCLUSIONS

Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.

A randomized controlled trial of an educational intervention to promote oral and dental health of patients with type 2 diabetes mellitus

Background

Diabetes is the most prevalent disease resulted from metabolic disorders. This study aimed to investigate the effect of training based on health belief model (HBM) on oral hygiene-related behaviors in patients with type 2 diabetes mellitus.

Methods

This study was conducted as an educational randomized controlled trial (single blind) on 120 patients with type 2 diabetes referring to a diabetes clinic selected through systematic sampling, who were assigned to two groups of control (N = 60) and intervention (N = 60). The data collection tool was a valid and reliable questionnaire based on HBM which was completed by both groups before the intervention. Then, the intervention group received 4 sessions of educational program based on HBM in 1 month, and the same questionnaire was completed again after 3 months and the data were analyzed through SPSS version 20 software with inferential statistics, t-test, paired t-tests, Chi square, Mann-Whitney test, and Wilcoxon test analysis.

Results

Three months after the intervention, awareness of the patients and perceived susceptibility, benefits, self-efficacy, internal cue to action, and performance in oral and dental hygiene-related behaviors had a significant increase in the intervention group (p < 0.05). So that the performance of oral and dental hygiene in the intervention group increased from 2.16 ± 0.71 to 3.25 ± 0.49 (p = 0.001) after the education.

Conclusion

Our results suggest that training patients with diabetes based on HBM as well as through active follow-up can enhance their skills in oral and dental hygiene-related behaviors. Controlling, monitoring and follow-up during the program are also recommended.

Trial registration

Iranian Registry of Clinical Trials, IRCT 2017050733847N1. Prospectively registered 14 June 2017, http://en.irct.ir/trial/26011

Innovations in Providing Diabetes Care for Individuals Experiencing Homelessness: An Environmental Scan

OBJECTIVES

For a variety of reasons, homelessness creates major challenges for the management of diabetes, resulting in excess morbidity and mortality in this population. The objective of this study was to document innovations in providing diabetes care for individuals experiencing homelessness.

METHODS

Using directed snowball sampling, we recruited a sample of service providers (family physicians, nurses, social workers, endocrinologists, diabetes educators, shelter workers) in 5 Canadian cities (Vancouver, Calgary, Edmonton, Toronto, Ottawa). Data were collected using detailed, open-ended interviews. Transcripts and field notes were analyzed using thematic analysis.

RESULTS

We interviewed 96 program managers and providers representing 38 organizations. Although many of the same challenges were faced by care providers in different jurisdictions, there was little communication or sharing of experiences across providers and organizations. However, we identified 5 unique and innovative approaches to providing diabetes care to individuals experiencing homelessness. These include: 1) provision of in-shelter care, 2) peer outreach/support workers, 3) diabetes specialty outreach clinics, 4) diabetes group care specific for this population and 5) community-based pharmacy interventions.

CONCLUSIONS

Providers and organizations in different cities face similar challenges in providing diabetes care to individuals who are experiencing homelessness, yet they tend to address these difficulties in isolation. Despite this, numerous organizations have created innovative solutions to improve diabetes care. Sharing experiences across organizations and jurisdictions can facilitate development and implementation of successful program models.

Assessing the nutritional needs of men with prostate cancer

BACKGROUND

Nutrition is important for prostate cancer (PC) survivorship care to help achieve a healthy weight, reduce treatment side effects and reduce the risk of developing other chronic diseases. We aimed to advance the understanding of the nutritional needs of men with PC and services that could be potentially implemented to address them.

METHODS

We conducted a needs assessment of nutrition services for men with PC drawing on four perspectives; 1) patient evaluation of a nutrition education session in British Columbia (BC), 2) survey of BC health professionals, 3) an environmental scan of existing nutrition services across Canada and 4) a scoping literature review.

RESULTS

Patients expressed a need for more nutrition information and a desire for additional nutrition services. More than 60% of health professionals believed there is a need for more nutrition services for men with PC, and reported the focus should be on weight management or management of PC progression. The environmental scan revealed few existing services for men with PC across Canada, most were inclusive of multiple cancers and not tailored for men with PC. Eighteen completed studies were identified in the scoping literature review. The majority provided combined diet and exercise programs with various formats of delivery such as individual, group and home-based. Overall, 78% of studies reported improvements in one or more of the following measures: dietary intake/ diet quality, body composition, self-efficacy, quality of life, fatigue, practicing health behavior goals and physical function/ exercise. Four studies assessed feasibility, adherence or satisfaction with all reporting positive findings.

CONCLUSION

Despite the high prevalence of PC in Canada, and the perceived need for more support by patients and health professionals, there are limited nutrition services for men with PC. Evidence from the literature suggests nutrition services are effective and well-accepted by men with PC. Our findings define a need for standardized nutrition services for men with PC that assess and meet long term nutritional needs. Our findings also provide insight into the type and delivery of nutrition services that may help close the gap in care for men with PC.

Effect of Health Education on Female Teachers' Knowledge and Practices Regarding Early Breast Cancer Detection and Screening in the Jazan Area: a Quasi-Experimental Study

Educational programs are important tools for breast cancer prevention. The purpose of this study was to assess the effectiveness of health education in improving the knowledge and practices of female teachers regarding screening tools and the early detection of breast cancer. A two-group quasi-experimental design was conducted among 150 female teachers, who were selected from 75 schools of the Jazan General Administration of Education. Schools were chosen by a simple cluster randomization method and non-randomly assigned to either the intervention or control group. Eligible participants were recruited by a simple randomization method, proportional to the total number of teachers at each school. Those in the intervention group (n = 75) were compared to the control group (n = 75) at baseline, as well as at 6 weeks and 3 months post-intervention. Knowledge of breast cancer screening tools was measured using a modified version of the Breast Cancer Knowledge test. Breast self-examination, clinical breast examination, and mammography practices were also measured. Compared to the control group, the intervention group showed a statistically significant increase in knowledge and practice levels at both 6 weeks and 3 months post-intervention. Thus, the results of this study provide evidence that group health education programs are effective in improving breast cancer knowledge and practices in female teachers. Clinical Trial Registration number: NCT03398057 .

Using intervention mapping approach to finding socio-cognitive determinants of diabetes preventive behaviors

INTRODUCTION

Diabetes is one of the most common chronic illnesses with complications. The objective of this study was to determine socio-cognitive determinants of diabetes preventive behaviors among sample of at risk group based on intervention mapping approach (IM) in Kermanshah, the west of Iran.

METHODS

This cross-sectional study conducted among a total of 200 male and female aged more than 30 years old referred to health centers that randomly selected to participate voluntarily, during 2018. Participants filled out a self-report questionnaire. Data were analyzed by SPSS version 16 using bivariate correlations and linear regression at 95% significant level.

RESULTS

The mean age of respondents was 38.4 years [95% CI: 37.3, 39.4], ranged from 30 to 56 years. Socio-cognitive determinants were accounted for 40% of the variation in diabetes prevention behaviors F = 35.559, P < 0.001. As well as, perceived self-efficacy, perceived severity, and perceived barrier were the most influential predictors on diabetes preventive behaviors.

CONCLUSIONS

It seems that planning health promotion programs to reduce barrier to perform diabetes preventive behaviors and increase confidence towards ability to perform preventive behaviors, and seriousness about sides effect of diabetes may be usefulness of the results in order to promotion of diabetes preventive behaviors among at risk group.

Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs.

Objective

To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care.

Methods

This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA_1c) will be the primary outcome measure.

Results

This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019.

Conclusions

This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D.

International Registered Report Identifier (IRRID)

DERR1-10.2196/10250

Why WAIT? Preliminary evaluation of the weight assistance and intervention techniques (WAIT) group

Individuals who attempt to lose weight may struggle because they lack skills to address problematic eating behaviors. There are multiple programs that have taught patients some of these behavioral strategies; however, it is not clear which strategies patients find to be the most useful. The purpose of this study was to examine preliminary outcomes after completion of a six-week integrative group for weight management. Retrospective chart reviews were conducted of 51 patients who completed an integrative, psychological weight management group. Patients were mailed surveys 1-2 years after completion of the group assessing for current problematic eating behaviors (i.e. emotional eating and food addiction), satisfaction with treatment, and skills they continue to use. The majority of patients lost weight, were satisfied with the group, found the group to be helpful, and felt confident they could maintain behavior changes. The strategies patients most commonly continued to use post-group included mindful eating, keeping a food diary, carrying out an exercise plan, regular weigh-ins, and planning for social eating. The number of food addiction symptoms decreased from pre- to post-group. An integrative psychological weight management group may provide patients with skills and confidence to assist with managing problematic eating behaviors and weight loss.

Integrating Local Knowledge into a National Programme: Evidence from a Community-Based Diabetes Prevention Education Programme

Type 2 diabetes prevention is a major priority for healthcare services and public health. This study aimed to evaluate how a local authority in England piloted a diabetes prevention programme. The South Gloucestershire Diabetes Prevention (Pilot) Programme (SGDPP) comprised a group health education course over six weeks with subsequent support provision up to six months post-enrolment. Of the 300 patients invited onto the programme, 32% enrolled and 29% completed the full six-month programme. There was an attendance rate of 84% throughout group sessions and at a six-month follow-up. There were significant improvements across most measures at six months, including a 4 kg mean weight loss and a 3.45 mmol/mol mean HbA1c reduction. Clear goals, high quality organization and personal qualities of educators were identified as central for the programme’s success. The unit costs were similar to pilots of other healthy lifestyle programmes. The evaluation found evidence of reduced type 2 diabetes risk markers, positive impacts for dietary and physical activity, and potential cost-effectiveness for this format of group-based diabetes prevention intervention. Feedback from multiple stakeholders provided insight on how to successfully embed and scale-up delivery of diabetes prevention work. This evidence enables the integration of learning in local service delivery and provides a basis to support development of the national diabetes prevention programme.

Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers

Introduction The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main primary healthcare provider and provides assistance and protection to around 5 million Palestine refugees in Jordan, Lebanon, Syria, West Bank and Gaza. Diabetes mellitus (DM) is a common problem among Palestine refugees, with a prevalence of 11.0%. In 2014, UNRWA embarked on a diabetes campaign to assist both patients with DM and staff in improving diabetes care management, by building the capacity of UNRWA's health staff and improving the knowledge and lifestyle behaviors among Palestine refugees with DM. Method Using a quasiexperimental study, we randomly selected 50 patients with diabetes from the 32 largest UNRWA health centers (HC); a total of 1600 participants were enrolled. Each HC conducted weekly group sessions for 6 months, including education, healthy cooking, and physical exercise. Body measurements, 2-hour postprandial glucose test, blood pressure and session attendance were collected on a weekly basis. Demographical data, pre/postquestionnaires and cholesterol levels were collected before and after the campaign. Paired t-test in SPSS V.21 was used. Results Out of 1600 patients, 1598 (1186 (74.0%) females and 412 (26.0%) males) completed the campaign; 576 (36.0%) patients had diabetes type 2 (DMII), 960 (60.0%) had DMII and hypertension and 62 (4.0%) had diabetes type 1 (DMI). After the campaign, the average weight loss was 2.6 kg (95% CI 2.4 to 2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (WC) (p≤0.001 for all). The session attendance rate was 70.6% in total. Conclusions This campaign focused on raising healthy lifestyle awareness and practices among Palestine refugees with DM. It was associated with reduction cardiometabolic risk factors. Similar campaigns need to be sustained and expanded. Local community and non-governmental organization partnerships observed during the campaign should be strengthened and sustained.

Behavioral interventions to improve self-management in Iranian adults with type 2 diabetes: a systematic review and meta-analysis

PURPOSE

The aim of this study was to systematically-review published experimental studies to determine the effectiveness of behavioral interventions on self-management in Iranian adults with type 2 diabetes.

METHOD

Pub Med, Web of Science, Science Direct, Ovid Medline, EBSCO, ProQuest, Google Scholar, and the Scientific Information Database (SID) were searched for English and Persian language studies published between 2009 and 2017. The primary outcome of this review was to assess the effects of behavioral interventions on glycosylated hemoglobin. Changes in the blood pressure, Lipid profiles, BMI, Self-efficacy, knowledge, attitude, practice, Self-care behaviors, social support, anxiety, and depression were the secondary outcomes.

RESULTS

Comprehensive search procedures resulted in twenty-three experimental studies with 2208 participants. Eleven studies were included in the Meta-analysis. Compared with the control group, behavioral interventions significantly lower glycosylated hemoglobin -0.61% (95% CI -0.80, -0.41). To explore the effects of the study intervention (regarding what aspects of the intervention are most effective), we then conducted a stratified analysis for HbA1c. Larger effects were found in interventions with a longer duration and higher intensity, delivered in the group format, interventions offered to individuals with higher baseline HbA1c, and interventions delivered by a multidisciplinary team. Moreover, behavioral interventions were effective in improving blood glucose, lipid profiles, knowledge, attitude, practice, self-efficacy, quality of life, and self-care.

CONCLUSION

In line with other behavioral studies, our study shows that behavioral interventions improve self-management in Iranian adults with type 2 diabetes.

People with diabetes do not learn and recall their diabetes foot education: a cohort study

PURPOSE

Diabetes education for those patients at risk of diabetes complications remains a mainstay of diabetes treatment. This study aimed primarily to determine the retention of foot health information 6 months post delivery of education. The secondary aim was to determine the type and delivery method of diabetes-specific foot health information during a podiatry consultation.

METHODS

This study was a prospective cohort study with two groups: patients with diabetes and their treating podiatrist. Baseline data collection included educational topics and delivery methods discussed during the consultation. The Problem Areas in Diabetes Questionnaire (PAID) and perceived key educational message were collected from each group's perspective at baseline and 6 months afterwards.

RESULTS

Three podiatrists and 24 participants with diabetes provided information at the two time points. At baseline, the key messages of 14 (58%) patient participant responses differed from their podiatrists and 15 (63%) differed 6 months later. Education covered up to seven separate topics, including neurological impact of diabetes, vascular supply and general foot care. The majority of consultations (n = 23, 96%) covered three or more topics.

CONCLUSIONS

Education is vital to effective treatment of people with diabetes. Current common approaches used in individual consultations such as verbal explanations appear ineffective in aiding the learning and retention of podiatry-specific diabetes education. This study highlights the need for research investigating more effective methods to deliver key education to this population to aid retention and therefore assist behaviour change.