Use of Recommended Communication Techniques by Diabetes Educators

‘Analogy-Based Comprehensive Diabetes Education’ (ABCDE) Improves Glycemic Control of Diabetic Patients in an Underserved Population: Results of a Retrospective Chart Analysis

Diabetes is the leading global cause for blindness, kidney failure and amputations. Preventing these complications requires optimal glycemic control, and it is imperative that diabetic patients understand the fundamental concepts of diabetes care. Although patients attend formal diabetes education classes, many do not comprehend basic concepts of diabetes, and are often noncompliant with diet, exercise and medications. A novel approach termed ‘analogy-based comprehensive diabetes education’ (ABCDE) was developed to educate HIV-patients with diabetes about basic concepts of diabetes care. The object of this manuscript is to report the results of a retrospective chart review on the impact of ABCDE on glycemic outcomes in 24 patients who had failed usual care (including formal diabetes education, physician visits, and diabetic medications), and were non-adherent with diet and medications. They received only the ABCDE without any changes in pharmacotherapy. The impact on glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) was assessed at subsequent visits. HbA1c was found to decline by 22% and 33% after 3 and 6 months, respectively, with corresponding declines in FBG by 53% and 59%, respectively. These results suggest that ABCDE in outpatient diabetes clinics could be effective in behavior modification toward improving glycemic control, and warrants additional investigation.

Core competencies for diabetes educators: A scoping review

AIMS

Diabetes educators (DEs) play a major role in diabetes education and management. The aims of this scoping review were to compile the currently identified core competencies for DEs and, to review the currently used criteria to assess DEs' core competencies.

METHODS

A scoping review was conducted using the methodology of the Joanna Briggs Institute. Five databases (Ovid, CINAHL, Scopus, Web of Science and PubMed) were searched. Keywords as well as inclusion and exclusion criteria were identified as search strategies and study selection for this review.

RESULTS

A total of (n = 22) publications comprising sixteen peer-reviewed studies and six professional-organisations (grey literature) were selected for review, as they listed the core competencies of DEs. The most common core competencies were related to knowledge and skills in diabetes self-management education, knowledge of pathophysiology and epidemiology, teaching skills, clinical skills and cultural competency. Evidently, an appropriate tool for assessing DEs' competencies is currently unavailable.

CONCLUSIONS

Given the importance of diabetes education in the care of people living with diabetes, it is imperative that DEs possess competencies in diabetes education and management. The review also identified the need to develop a globally applicable core competency assessment tool for DEs.

The HLKES-2: Revision and Evaluation of the Health Literacy Knowledge and Experiences Survey

BACKGROUND

Low health literacy impacts individual health and the health care system. The Health Literacy Knowledge and Experience Survey (HLKES) was created to evaluate preparedness of nurses to provide health literate care. However, the instrument was developed a decade ago and needs revision. The purpose of this study was to update and shorten the HLKES into a feasible, valid, and reliable instrument.

METHOD

The HLKES was refined into a 14-item instrument (10 knowledge questions and four experience questions). Expert review was obtained. Face validity was assessed, and pilot and field testing with students was conducted.

RESULTS

Scale content validity index was 0.95, and individual questions demonstrated appropriate item difficulty and discrimination. Cronbach's alpha coefficient was .565 for the 10 multiple choice questions and .843 for the four Likert-type questions, indicating good reliability.

CONCLUSION

A reliable and valid HLKES-2 was developed to evaluate health literacy knowledge and experiences in a contemporary setting. [J Nurs Educ. 2019;58(2):86-92.].

The AMA Communication Techniques Survey: A Psychometric Analysis

BACKGROUND

Health care providers are continually seeking to improve patient communication to improve patient outcomes. The American Medical Association (AMA) developed a set of recommended communication practices and an instrument to evaluate health care providers' use of and perceived effectiveness of these techniques.

OBJECTIVE

The purpose of the study was to assess factor structure of the AMA Communication Techniques Survey using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to evaluate reliability of the instrument among nurses and allied health professionals who provide diabetes education.

METHODS

A national convenience sample of 522 diabetes educators completed the survey; this sample was split into two subsamples-the EFA (n = 302) and CFA (n = 220). Of this sample, 60.2% (n = 314) were nurses. Factor structure and reliability analysis of the AMA Communication Techniques Survey was conducted.

KEY RESULTS

EFA with varimax rotation revealed two internally consistent subscales labeled basic and advanced communication techniques. CFA determined that basic and advanced technique subscales were a good fit for the factors. Basic techniques included items such as speaking slowly and using simple words. Advanced techniques included the Teach-Back method, underlining words in printed materials, and presenting 2 to 3 concepts at a time. The Cronbach's alpha coefficient for the total scale was .81 and .70 (basic subscale) and .74 (advanced subscale), indicating good reliability.

CONCLUSIONS

The AMA Communication Techniques Survey appears to be a valid and reliable instrument to examine communication practices of diabetes educators. Additionally, EFA confirms previously hypothesized basic and advanced subscales. However, the factors included in each scale differ from previous conceptualization. [Health Literacy Research and Practice. 2017;1(4):e208-e215.].

PLAIN LANGUAGE SUMMARY

This study established reliability and validity for the American Medical Association Communication Technqiues Survey among diabetes educators. Data support the creation of two separate groups of items: basic and advanced techqniues.