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Lawton J, Chadwick PM, de Zoysa N, Stanton-Fay S, Heller SR, Rankin D. Participants' experiences of attending a structured education course (DAFNEplus) informed by behavioural science. Diabet Med 2024:e15309. [PMID: 38361333 DOI: 10.1111/dme.15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
AIMS As part of a broader process evaluation, we explored participants' experiences of, and engagement with, the DAFNEplus programme's group-based structured education course. This course, which was informed by behavioural science, provided participants with education and instruction to use flexible intensive insulin therapy (FIIT) together with techniques to identify and address unhelpful cognitive and emotional influences on their type 1 diabetes self-management. METHODS We interviewed n = 28 DAFNEplus participants. Data were analysed thematically and took account of previous work exploring individuals' experiences of standard DAFNE courses. RESULTS As well as benefitting from the DAFNEplus course's skills-based training and educational curriculum, participants' accounts suggested they had experienced cognitive and emotional changes that had positively influenced their confidence and motivation to adopt and sustain the use of FIIT. These benefits were most keenly felt by those who reported negative emotional states and mind-sets pre-course which had made their diabetes self-management challenging. Participants' cognitive and emotional changes were enabled through techniques used during the course to normalise setbacks and imperfect diabetes self-management, capitalise upon group synergies and encourage the use of social support, including from healthcare professionals. Participants also highlighted motivational gains arising from being reassured that diabetes complications are not common or inevitable if a FIIT regimen is followed. CONCLUSIONS Our findings suggest that offering training in FIIT, in conjunction with behaviour change techniques that target unhelpful mindsets and emotional resilience, may be more effective in promoting diabetes self-management than offering education and skills training alone.
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Affiliation(s)
- Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | - Paul M Chadwick
- UCL Centre for Behaviour Change, University College London, London, UK
| | | | | | - Simon R Heller
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
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2
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Jamwal T, Kumar R, Pulle MV, Kumar A, Jain K. Does Structured Patient Education Reduce the Peri-Operative Anxiety and Depression Levels in Elective Chest Surgery Patients? A Double-Blinded Randomized Trial of 300 Patients. J Patient Exp 2023; 10:23743735231151535. [PMID: 36698623 PMCID: PMC9869230 DOI: 10.1177/23743735231151535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Psychological distress associated with surgery is an emerging issue. The study was conducted to assess the impact of structured patient education viz-a-viz routine patient education on anxiety and depression levels in patients undergoing elective chest surgery. It is a prospective, double-blind randomized study, conducted from February 2019 to February 2020 at a tertiary care center in India, on patients who underwent elective chest surgeries. A total of 300 patients were randomized using a computer-generated randomization sequence, into 2 equal groups (150 subjects each). Study group included patients who underwent structured patient education (Group A), whereas control group included patients who underwent routine patient education (Group B). The 2 groups were compared for anxiety and depression levels at admission as well as discharge using Hospital Anxiety and Depression Scale. Also, at the time of discharge, the groups were compared for the effectiveness of patient education using a validated Questionnaire B. In comparison to routine education, patients receiving structured education showed significantly lesser scores for anxiety and depression at discharge (P < .001). Also, structured patient education proved to be effective in comparison to the routine education in educating the patients in all parameters as determined by the Questionnaire B (P < .05). It can be concluded that structured educational intervention is strongly recommended in patients undergoing chest surgery which can help alleviate perioperative anxiety and depression. Such intervention helps patient get an understanding of the surgical procedure and assist them in facing the condition in a better way.
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Affiliation(s)
- Tilotma Jamwal
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India,Tilotma Jamwal, Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Reena Kumar
- Department of Hospital Administartion, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Arvind Kumar
- Institute for Chest Surgery, Medanta Hospital, Gurugram, India
| | - Kanika Jain
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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3
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Blythin AM, Elkes J, van Lindholm T, Bhogal A, Wilkinson TMA, Saville C, Kirk A. Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage. Digit Health 2023; 9:20552076221147109. [PMID: 36923369 PMCID: PMC10009031 DOI: 10.1177/20552076221147109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/06/2022] [Indexed: 03/16/2023] Open
Abstract
Objective Structured diabetes education has evidenced benefits yet reported uptake rates for those referred to traditional in-person programmes within 12 months of diagnosis were suboptimal. Digital health interventions provide a potential solution to improve diabetes education delivery at population scale, overcoming barriers identified with traditional approaches. myDiabetes is a cloud-based interactive digital health self-management app. This evaluation analysed usage data for people with type 2 diabetes focusing on digital structured diabetes education. Methods Descriptive quantitative analyses were conducted on existing anonymised user data over 12 months (November 2019-2020) to evaluate whether digital health can provide additional support to deliver diabetes education. Data was divided into two equal 6-month periods. As this overlapped the onset of COVID-19, analyses of its effect on usage were included as a secondary outcome. All data was reported via myDiabetes. Users were prescribed myDiabetes by National Health Service healthcare primary care teams. Those who registered for app use within the study period (n = 2783) were assessed for eligibility (n = 2512) and included if activated. Results Within the study period, n = 1245/2512 (49.6%) registered users activated myDiabetes. No statistically significant differences were observed between gender (p = 0.721), or age (p = 0.072) for those who activated (59.2 years, SD 12.93) and those who did not activate myDiabetes (57.6 years, SD 13.77). Activated users (n = 1119/1245 (89.8%)) viewed 11,572 education videos. No statistically significant differences were observed in education video views across age groups (p = 0.384), gender (p = 0.400), diabetes treatment type (p = 0.839) or smoking status (p = 0.655). Comparison of usage pre-COVID-19 and post-COVID-19 showed statistically significant increases in app activity (p ≤0.001). Conclusion Digital health is rapidly evolving in its role of supporting patients to self-manage. Since COVID-19 the benefits of digital technology have become increasingly recognised. There is potential for increasing diabetes education rates by offering patients a digital option in combination with traditional service delivery which should be substantiated through future research.
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Affiliation(s)
- A M Blythin
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - J Elkes
- School of Public Health, Imperial College Clinical Trials Unit, London, UK
| | - T van Lindholm
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - A Bhogal
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - T M A Wilkinson
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK.,Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - C Saville
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - A Kirk
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
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4
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Fallon C, Jones E, Oliver N, Reddy M, Avari P. The impact of socio-economic deprivation on access to diabetes technology in adults with type 1 diabetes. Diabet Med 2022; 39:e14906. [PMID: 35751860 PMCID: PMC9544624 DOI: 10.1111/dme.14906] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio-economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. METHODS Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio-economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one-way ANOVAs and chi-squared tests. RESULTS In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real-time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). CONCLUSIONS Adults living in the most deprived quintile had less technology use. Irrespective of socio-economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.
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Affiliation(s)
- Ciara Fallon
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma Jones
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Nick Oliver
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Monika Reddy
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Parizad Avari
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
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5
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Jiang X, Jiang H, Tao L, Li M. The Cost-Effectiveness Analysis of Self-Efficacy-Focused Structured Education Program for Patients With Type 2 Diabetes Mellitus in Mainland China Setting. Front Public Health 2021; 9:767123. [PMID: 34957020 PMCID: PMC8695800 DOI: 10.3389/fpubh.2021.767123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the long-term (50 years) cost-effectiveness of the self-efficacy-focused structured education program (SSEP) as opposed to routine education among patients with type 2 diabetes mellitus (T2DM) in mainland China from a healthcare service perspective. Methods: A cost-effectiveness analysis method was used. The IQVIA CORE Diabetes Model (version 9.0) was adopted to estimate the outcomes. The baseline cohort characteristics, variations of physiological parameters, costs of intervention and other treatments, and management-related diabetes were derived from a randomized controlled trial. Moreover, the complications costs and utilities were extracted from published sources. Furthermore, the univariate sensitivity analysis and the probabilistic sensitivity analysis were conducted. Results: As compared with the control group, the life expectancy and quality-adjusted life-year in the intervention group were increased. Besides, the intervention group achieved lower cumulative incidences of complications and saved more direct medical costs compared with the control group. The sensitivity analysis revealed that the SSEP had 100% probability to be cost-effective. Conclusion: The SSEP is recognized as a highly cost-effective option for managing patients with T2DM, which are projected to both improve clinical outcomes and reduce costs.
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Affiliation(s)
- Xinjun Jiang
- Department of Adults Nursing, School of International Nursing, Hainan Medical University, Haikou, China
- Department of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, China
- Key Laboratory of Trauma of Hainan Medical University, Hainan Medical University, Haikou, China
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Hua Jiang
- Department of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Libo Tao
- Center for Health Policy and Technology Evaluation, Peking University Health Science Center, Beijing, China
| | - Mingzi Li
- Department of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China
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6
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Alahmari KA, Rengaramanujam K, Reddy RS, Silvian Samuel P, Ahmad I, Nagaraj Kakaraparthi V, Tedla JS. Effect of Disability-Specific Education on Student Attitudes Toward People With Disabilities. Health Educ Behav 2021; 48:532-539. [PMID: 33703935 DOI: 10.1177/1090198121995774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attitude is a multidimensional and complex notion that considerably empowers or limits the major life activities of humans. Health professionals' attitudes toward people with disabilities are significant factors in the rehabilitation process. Soon after completing their coursework, the final-year students from health science meet the patients and rehabilitate them. This study accordingly aims to assess the attitude toward disability among final-year health science students before and after administering a disability-specific structured teaching program. A total of 243 final-year undergraduate health science students from medical, dental, physical therapy, pharmacy, laboratory sciences, radiology sciences, and nursing aged between 21 and 27 years participated in this study. This work employed the Scale of Attitudes Toward Disabled Persons (SADP) to measure attitudes among participants. The mean pre- and posttest SADP scores were 83.59 ± 15.45 and 107.83 ± 62, respectively (p < .001). Students from medical, dental, physical therapy, and nursing showed significant positive attitudes toward disability compared with other students, whereas college students in the final year of health science generally had poor attitudes toward disability. The results indicate that the disability-specific structured teaching program is effective in improving the attitude toward disability among final-year health science students. Accordingly, the authors recommend modifying the disability-related content in the health sciences curriculum.
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Affiliation(s)
| | | | | | | | - Irshad Ahmad
- King Khalid University, Abha, Kingdom of Saudi Arabia
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7
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Pemberton JS, Kershaw M, Dias R, Idkowiak J, Mohamed Z, Saraff V, Barrett TG, Krone R, Uday S. DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia. Pediatr Diabetes 2021; 22:249-260. [PMID: 33205572 DOI: 10.1111/pedi.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). DESIGN AND METHODS Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9-10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. RESULTS Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. CONCLUSION Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.
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Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Melanie Kershaw
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Renuka Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Idkowiak
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zainab Mohamed
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vrinda Saraff
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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8
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Abstract
Impaired awareness of hypoglycaemia (IAH) affects between 25% and 30% of all people with type 1 diabetes (T1D) and markedly increases risk of severe hypoglycaemia. This greatly feared complication of T1D impairs quality of life and has a recognised morbidity. People with T1D have an increased propensity to hypoglycaemia as a result of fundamental physiological defects in their ability to respond appropriately to a fall in blood glucose levels. With repeated exposure to low glucose, many then develop a condition referred to as IAH, where there is a reduced ability to perceive the onset of hypoglycaemia and take appropriate corrective action. The management of individuals with IAH relies initially on its identification in the clinic through a detailed exploration of the frequency of hypoglycaemia and an assessment of the individual's ability to recognise these episodes. In this review article, we will address the clinical strategies that may help in the management of the patient with IAH once identified, who may or may not also suffer from problematic hypoglycaemia. The initial focus is on how to identify such patients and then on the variety of approaches involving educational programmes and technological approaches that may be taken to minimise hypoglycaemia risk. No single approach can be advocated for all patients, and it is the role of the health care professional to identify the clinical strategy that best enables their patient to achieve this goal.
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Affiliation(s)
- Catriona M. Farrell
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
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9
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Abdelmohsen SA. Effectiveness of Structured Education on Patient's Knowledge and Practice Regarding Colostomy Care. Asia Pac J Oncol Nurs 2020; 7:370-374. [PMID: 33062833 PMCID: PMC7529020 DOI: 10.4103/apjon.apjon_24_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/30/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Evaluating the effectiveness of structured education on patient's knowledge and practice regarding colostomy care. Methods A quasi-experimental study design (pre-posttest) was utilized to fulfill the aim of the study. The study was carried out in the outpatient surgery clinic at South Egypt Cancer Institute; a nonprobability convenient sample of 60 adult male and female colostomy patients was included in the study. Two tools were utilized; Tool I: A structured interviewing questionnaire sheet, including three parts: Part I: Demographic characteristics of the studied patients, Part II: Assessment of colostomy, and Part III: Patients' knowledge regarding colostomy (pre-post); Tool II: A colostomy care observation checklist (pre/post). Results A highly statistically significant difference was found regarding total knowledge and practice scores of the studied sample pre- and post-application of the structured patient education. Conclusions On light of the present study results, it can be concluded that structured patient education was found to be effective in enhancing patient's knowledge and practices, regarding stoma and peristomal skin care.
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Affiliation(s)
- Sahar A Abdelmohsen
- Department of Nursing Sciences, College of Applied Medical Sciences - Wadi Alddawasir, Prince Sattam Bin Abdulaziz University, Saudi Arabia.,Department of Medical Surgical Nursing, Faculty of Nursing, Asyut University, Asyut, Egypt
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10
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Mehta G, Hirji A. The Outcome of Structured Education in Adults With Type 2 Diabetes Mellitus and Substance Use Disorder: A Literature Review. Can J Diabetes 2020; 44:487-493. [PMID: 32792102 DOI: 10.1016/j.jcjd.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/12/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Structured diabetes education for patients is a cornerstone of therapy; it empowers the patients by giving them appropriate tools for the self-management of the illness. The objective of this work was to determine how substance use disorder influences the outcome of structured diabetes education in patients with type 2 diabetes mellitus, and whether patients with substance use disorder are less likely to benefit because of their addiction issues. METHODS Only clinical trials involving substance use, which were randomized, in the context of type 2 diabetes mellitus were included. RESULTS Literature was only available for alcohol use disorder, and there were no studies available on any other recreational substance use disorders and its effects on structured diabetes education. Out of 3 relevant studies, in the context of alcohol use disorder, 2 studies identified alcohol use by the patients as a limiting factor in receiving structured diabetes education. One study did not show any impact of alcohol on structured diabetes education. CONCLUSIONS More high-quality randomized controlled trials with better sample sizes are required to say with confidence if alcohol use affects the patient's ability to participate in structured educational programs for type 2 diabetes mellitus management.
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Affiliation(s)
- Gaurav Mehta
- Department of Psychiatry, University of Toronto, Newmarket, Ontario, Canada.
| | - Alyssa Hirji
- Department of Psychiatry, University of Toronto, Newmarket, Ontario, Canada
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11
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Maine A, Brown MJ, Dickson A, Truesdale M. Pilot feasibility study of the Walking Away from Diabetes programme for adults with intellectual disabilities in two further education colleges: Process evaluation findings. J Appl Res Intellect Disabil 2019; 32:1034-1046. [PMID: 30941841 DOI: 10.1111/jar.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/11/2019] [Accepted: 02/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND People with intellectual disabilities remain at high risk of developing type 2 diabetes (T2D) due to lifestyle-associated risk factors. Educational programmes have been adapted for people with intellectual disabilities targeting ongoing T2D self-management. However, there are no adapted programmes which aim to prevent T2D through reducing risk factors. The present study initiates addressing this gap. METHODS Further education (FE) colleges in Scotland were recruited for feasibility study using the Walking Away (WA) from Diabetes programme. Process evaluation assessed recruitment, retention, baseline physical activity levels, and acceptability and accessibility using focus groups. RESULTS Ninety six percent of invited students agreed to participate. WA was positively received, and some short-term impact was described. Suggestions for further adaptations regarding materials, delivery and content were provided, including delivery embedded within FE college curriculum. CONCLUSIONS Recruitment, retention and acceptability provide rationale for further research on T2D prevention in FE colleges.
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Affiliation(s)
- Andrew Maine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Michael J Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Adele Dickson
- Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Maria Truesdale
- Edinburgh Napier University School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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12
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Mani H, Chudasama Y, Hadjiconstantinou M, Bodicoat DH, Edwardson C, Levy MJ, Gray LJ, Barnett J, Daly H, Howlett TA, Khunti K, Davies MJ. Structured education programme for women with polycystic ovary syndrome: a randomised controlled trial. Endocr Connect 2018; 7:26-35. [PMID: 29133383 PMCID: PMC5744630 DOI: 10.1530/ec-17-0274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a structured education programmes in women with polycystic ovary syndrome (PCOS). METHODS Single-centre, randomised controlled trial, testing a single exposure to a group-based, face-to-face, structured education programme. Inclusion criteria were women with PCOS, aged 18-49 years inclusive and body mass index ≥23 kg/m2 for black and minority ethnicities or ≥25 kg/m2 for white Europeans. Primary outcome was step-count/day at 12 months. Secondary outcomes included indices of physical activity, cardiovascular risk factors, quality of life (QoL) and illness perception (IP). RESULTS 161 women were included (78 control, 83 intervention); 69% white; mean age 33.4 (s.d. 7.6) years, of whom 100 (48 intervention; 52 control) attended their 12-month visit (38% attrition). 77% of the intervention arm attended the education programme. No significant change in step-count was observed at 12 months (mean difference: +351 steps/day (95% confidence interval -481, +1183); P = 0.40). No differences were found in biochemical or anthropometric outcomes. The education programme improved participants' IP in 2 dimensions: understanding their PCOS (P < 0.001) and sense of control (P < 0.01) and improved QoL in 3 dimensions: emotions (P < 0.05), fertility (P < 0.05), weight (P < 0.01) and general mental well-being (P < 0.01). DISCUSSION A single exposure to structured education programme did not increase physical activity or improve biochemical markers in overweight and obese women with PCOS. However, providing a structured education in parallel to routine medical treatment can be beneficial for participants' understanding of their condition, reducing their anxiety and improving their QoL.
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Affiliation(s)
- Hamidreza Mani
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Michelle Hadjiconstantinou
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Danielle H Bodicoat
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- The Leicester Biomedical Research CentreLeicester and Loughborough, UK
| | - Miles J Levy
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health SciencesUniversity of Leicester, Leicester, UK
| | - Janette Barnett
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Heather Daly
- Leicester Medical GroupThurmaston Health Centre, Leicester, UK
| | - Trevor A Howlett
- Department of Diabetes and EndocrinologyLeicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research CentreLeicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK
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Taylor J, Siddiqi N. Improving health outcomes for adults with severe mental illness and comorbid diabetes: is supporting diabetes self-management the right approach? J Psychiatr Ment Health Nurs 2016; 23:322-30. [PMID: 27307263 DOI: 10.1111/jpm.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/02/2023]
Affiliation(s)
- J Taylor
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - N Siddiqi
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK.,Bradford District Care NHS Foundation Trust, York, UK
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Eborall HC, Virdee SK, Patel N, Redwood S, Greenfield SM, Stone MA. "And now for the good news..." the impact of negative and positive messages in self-management education for people with Type 2 diabetes: A qualitative study in an ethnically diverse population. Chronic Illn 2016; 12:3-17. [PMID: 25827572 DOI: 10.1177/1742395315577965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/25/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the impact of Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) Foundation education, particularly from interviewees' narratives regarding recall of good and bad news messages and behaviour changes. METHODS In-depth, semi-structured interviews were conducted with a purposive sample (n=19) of people who had attended education sessions as part of a randomised controlled trial in two UK sites with ethnically diverse populations. Data collection and analysis were informed by the constant comparative approach and facilitated through charting. RESULTS Findings were similar in people from different ethnic backgrounds. Exploration of levels of recall of the sessions suggested that this was variable and sometimes very limited, but that interviewees had all assimilated some relevant learning. Key themes emerged relating to the way in which interviewees recalled and had been influenced by positive (good news) and negative (bad news) messages within the education sessions, including biomedical explanations. Both types of message appeared to have an important role in terms of motivation to change behaviour, but a notable observation was that none of the interviewees recalled receiving bad news messages when diagnosed. DISCUSSION Our findings have highlighted the importance of providing and combining both negative and positive messages within education designed to promote self-management behaviour change.
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Affiliation(s)
- Helen C Eborall
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, Leicester, UK
| | - Satnam K Virdee
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Margaret A Stone
- Diabetes Research Centre, University of Leicester, Leicester, UK
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15
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Troughton J, Chatterjee S, Hill SE, Daly H, Martin Stacey L, Stone MA, Patel N, Khunti K, Yates T, Gray LJ, Davies MJ. Development of a lifestyle intervention using the MRC framework for diabetes prevention in people with impaired glucose regulation. J Public Health (Oxf) 2015; 38:493-501. [PMID: 26311822 PMCID: PMC5072159 DOI: 10.1093/pubmed/fdv110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We report development of a group-based lifestyle intervention, Let's Prevent, using the UK Medical Research Council (MRC) framework, and delivered by structured education to prevent type 2 diabetes mellitus (T2DM) in people with impaired glucose regulation (IGR) in a UK multi-ethnic population. Methods Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is the first national T2DM programme that meets National Institute for Health and Care Excellence criteria and formed the basis for Let's Prevent. An iterative cycle of initial development, piloting, collecting and collating qualitative and quantitative data, and reflection and modification, was used to inform and refine lifestyle intervention until it was fit for evaluation in a definitive randomized controlled trial (RCT). The programme encouraged IGR self-management using simple, non-technical language and visual aids. Results Qualitative and quantitative data suggested that intervention resulted in beneficial short-term behaviour change such as healthier eating patterns, improved health beliefs and greater participant motivation and empowerment. We also demonstrated that recruitment strategy and data collection methods were feasible for RCT implementation. Conclusions Let's Prevent was developed following successful application of MRC framework criteria and the subsequent RCT will determine whether it is feasible, reliable and transferable from research into a real-world NHS primary healthcare setting. Trial Registration ISRCTN80605705.
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Affiliation(s)
- Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Sudesna Chatterjee
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Siân E Hill
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Heather Daly
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Lorraine Martin Stacey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Margaret A Stone
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Naina Patel
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Laura J Gray
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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Wong CKH, Wong WCW, Wan YF, Chan AKC, Chung KL, Chan FWK, Lam CLK. Patient Empowerment Programme in primary care reduced all-cause mortality and cardiovascular diseases in patients with type 2 diabetes mellitus: a population-based propensity-matched cohort study. Diabetes Obes Metab 2015; 17:128-35. [PMID: 25251664 DOI: 10.1111/dom.12397] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
AIMS To assess whether a structured diabetes education programme, the Patient Empowerment Programme (PEP), was associated with a lower risk of first cardiovascular disease (CVD) event and all-cause mortality in a population-based cohort of patients with type 2 diabetes mellitus (T2DM) in primary care. METHODS A Chinese cohort of 27 278 patients with T2DM and without previous CVD events on or before the baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. The PEP was provided to patients with T2DM treated at primary care outpatient clinics through community trained professional educators. PEP non-participants were matched one-to-one with the PEP participants using a propensity score method with respect to their baseline covariates. Cox proportional hazard regression was performed to estimate the associations of the PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure and death from any cause, controlling for baseline characteristics. RESULTS During a median of 21.5 months follow-up, 795 (352 PEP participants and 443 PEP non-participants) patients experienced a first CVD event. After adjusting for confounding variables, PEP participants had a lower rate of all-cause mortality [hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.445-0.715; p < 0.001], first CVD (HR 0.807, 95% CI 0.696-0.935; p = 0.004) and stroke (HR 0.702; 95% CI 0.569-0.867; p = 0.001) than those without PEP. CONCLUSIONS Enrolment in the PEP was associated with lower all-cause mortality and a lower number of first CVD events among patients with T2DM. The CVD benefit of PEP might be attributable to improving metabolic control through empowerment of self-care and the enhancement of quality of diabetes care in primary care.
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Affiliation(s)
- C K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Island, Hong Kong
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Guo XH, Ji LN, Lu JM, Liu J, Lou QQ, Liu J, Shen L, Zhang MX, Lv XF, Gu MJ. Efficacy of structured education in patients with type 2 diabetes mellitus receiving insulin treatment. J Diabetes 2014; 6:290-7. [PMID: 24279284 DOI: 10.1111/1753-0407.12100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/11/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of the present study was to assess the efficacy of structured education in insulin-treated type 2 diabetes mellitus (T2DM) patients. METHODS In a 16-week open-label randomized controlled study, 1511 T2DM patients with inadequate responses to two or more oral antidiabetic drugs (OADs) for >3 months (HbA1c >7.5%) were randomized (1:1) to either an education group (structured diabetes education plus insulin therapy) or a control group (usual care plus insulin therapy). Both groups discontinued previous OADs (except biguanides and α-glucosidase inhibitors) and started twice daily injections of 30% soluble-70% isophane recombinant insulin. The primary endpoint was the change in HbA1c from baseline. Efficacy and safety data were analyzed for within- and between-group differences. RESULTS Of the initial 1511 patients, 1289 completed the study (643 in the control group; 646 in the education group). At the end of the study, significant reductions in HbA1c versus baseline were evident in both groups, but the reduction was greater in the education group (2.16% vs. 2.08%; P < 0.05). A higher proportion of patients in the education group achieved target HbA1c levels <7% (43.81% vs. 36.86%; P < 0.05) and ≤6.5% (28.48% vs. 22.71%; P < 0.05). In addition, patients in the education group showed greater increments in scores and improvement in the Morisky Medication Adherence Scale (P < 0.05). The overall incidence of hypoglycemic events was similar in the two groups. CONCLUSIONS Structured education can promote the ability of patients to self-manage and their compliance with medications, thereby achieving better outcomes.
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Affiliation(s)
- Xiao Hui Guo
- Peking University First Hospital, Beijing, China
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