Examining the influence of family support on diabetes education behavioural outcomes

The purpose of this study was to examine the influence of family support on diabetes education behavioural outcomes, specifically in relation to diet, exercise, and blood glucose monitoring in adult individuals with Type 2 diabetes. Fifty-three individuals attending diabetes education for the first time were followed approximately 1 month. The findings for the influence of family support were mixed. Family attending diabetes class with participants had a positive influence with respect to diet. This is consistent with Carl Rogers (1969) who espouses setting a positive climate for learning and that learning new attitudes or information comes when external barriers are at a minimum. However family attending class with participants had no influence with respect to exercise or blood glucose monitoring. The family support action of encouraging with respect to diet overall did not influence healthy eating behaviours except for decreased skipped meals and scheduled snacks. In fact, in the areas of family willing to make healthy choices along with participant, the less the family was involved in encouraging, the better the participant did. Exercise on the other hand was influenced positively by family encouragement. This is consistent with Bandura's theory that enhancement of self-confidence and self-efficacy can lead to desired behaviour changes. Family encouragement however did not appear to influence blood glucose monitoring behaviours. This study has implications for practice in that diabetes education programs can encourage family to attend classes or get involved in encouraging the person with diabetes, so that it may help to increase healthy eating behaviours and exercise. As time is necessary to implement changes in behaviour, future research can look at the influence of family support over a 6-month, I-year, or greater period.

Understanding the Cultural Health Beliefs in Diabetes Education Amongst the Aboriginal Population within a City in the Southern Region of Ontario

This study examined the cultural health beliefs in diabetes education amongst the Aboriginal population within a city in Southern Ontario. The purpose was to contribute to the development of a culturally relevant diabetes handbook as well as to delivery styles within current diabetes education programs. To this end, a focus group was conducted with Aboriginal men and women between the ages of 18-70 years with type 2 diabetes. Participants were recruited from 2 Aboriginal community centres and an Aboriginal health centre in a city in Southern Ontario. Themes were drawn from the analysis of the focus group transcripts and combined with the findings from the research literature. The major themes that merged were drawn from Eurocentric and Aboriginal theories. The results were a set of recommendations on the type of format for diabetes educational programs such as traditional group activities, variety of electronic format, and culture specific educational resources. The emergent results appear to provide some important insights into program planning for diabetes education centres within Aboriginal communities.

Diabetes education : art, science and evidence

Diabetes education is a process, the key to which is establishing a therapeutic relationship with the individual. The overall goal of diabetes education is to enhance the individual's health capability, including their ability to solve problems and apply the learning to self-care. Thus, diabetes education is an interactive process of teaching and learning where information is co-generated. This innovative new book explores the 'how' of diabetes education, rather than the 'what' and the 'why'. This thought stimulating textbook will helping health care practitioners to teach diabetes effectively from diagnosis and ensure people living with diabetes get the individualised support and information. It will enable practitioners and educators to examine and reflect on their practice when managing the diabetic patient. Bringing together all the thinking and experience on the diabetes journey in one text, this book will be essential reading for all practitioners and students in involved in diabetes care

Structured Type 1 Diabetes education delivered within routine care: impact on glycemic control and diabetes-specific quality of life

OBJECTIVE:
To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care.

RESEARCH DESIGN AND METHODS:
Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes.

RESULTS:
There were significant improvements in HbA_1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points.

CONCLUSIONS:
Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.

Preparing health professionals to work in diabetes education and care: a situation analysis

Worldwide, the increasing prevalence of chronic diseases places enormous expectations of and responsibility on health systems. Preparing the health workforce to adequately respond to these increasing demands is a challenge of critical importance. The aim of this study was to provide an overview of how health professionals (HPs) are prepared to work in diabetes care and education. A one shot cross-sectional study was undertaken to collect the data using self-completed anonymous on-line questionnaires. The invitation to complete the questionnaire was sent to more than 3745 HPs. One thousand one hundred and sixteen responses were collected, 68% were from highincome countries and 32% from middle- and low-income countries (LMIC). Most HPs developed their knowledge and skills through work experience and self-study: very few attended a formal education program as part of their training. Thirty-six percent of LMIC respondents did not have a credential/certification in diabetes and 72% reported their organizations support them to learn about diabetes education/care. Moreover, 80% referred to the International Diabetes Federation publications when making clinical decisions or planning diabetes care. Results provide insight into how HPs are educationally prepared to work in diabetes education and care and could serve as a foundation for future research. These findings emphasize the emerging necessity to develop certified/credentialing programs for HPs, especially in LMIC.

Participating creatively: e-portfolio learning in diabetes education on the cloud

Abstract: The evolution of online teaching in higher education demands a change in the types of pedagogical philosophies and methods used in these courses. This chapter will discuss how a jigsaw model facilitated independent learning and enhanced student learning by working in teams. To accomplish this objective each student needed to communicate with a small group of other students on line and contribute equally for a common goal. A parallel aim was to overcome postgraduate students’ reluctance to utilise technology and communicate within the Cloud, in particular when student groups are big. The authors have found that postgraduate students often experience a sense of learning in isolation. An added benefit was the social dimension experienced within the activity. The chapter will reveal how a jigsaw style integrated learning tool was a successful collaborative learning experience in a classroom setting. The jigsaw activity was designed to enable students to share ‘artefacts’ and knowledge with a small group of students and the lecturer by using the E-Portfolio.  In conclusion, it will be argued that this creative and innovative participatory Cloud learning experience offered more students the opportunity to collaborate within a team in the Cloud. This E-portfolio learning activity introduced the electronic style of information sharing to postgraduate students and additionally the interactive and creative jigsaw learning activity assisted students to navigate the Cloud, use E-portfolio and engage in an environment in which they felt comfortable to communicate in.

Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: the OzDAFNE program

AIMS: To evaluate structured type 1 diabetes education delivered in routine practice throughout Australia.

METHODS: Participants attended a five-day training program in insulin dose adjustment and carbohydrate counting between April 2007 and February 2012. Using an uncontrolled before-and-after study design, we investigated: HbA1c (% and mmol/mol); severe hypoglycaemia; diabetes ketoacidosis (DKA) requiring hospitalisation, and diabetes-related distress (Problem Areas in Diabetes scale; PAID), weight (kg); body mass index. Data were collected pre-training and 6-18 months post-training. Change in outcome scores were examined overall as well as between groups stratified by baseline HbA1c quartiles. Data are mean±SD or % (n).

RESULTS: 506 participants had data eligible for analysis. From baseline to follow-up, significant reductions were observed in the proportion of participants reporting at least one severe hypoglycaemic event (24.7% (n=123) vs 12.1% (n=59), p<0.001); and severe diabetes-related distress (29.3% (n=145) vs 12.6% (n=60), p<0.001). DKA requiring hospitalisation in the past year reduced from 4.1% (n=20) to 1.2% (n=6). For those with above target baseline HbA1c there was a small, statistically significant improvement (n=418, 8.4±1.1% (69±12mmol/mol) to 8.2±1.1% (66±12mmol/mol). HbA1c improvement was clinically significant among those in the highest baseline quartile (n=122, 9.7±1.1% (82±11mmol/mol) to 9.0±1.2% (75±13mmol/mol), p<0.001).

CONCLUSIONS: The proportion of participants reporting severe hypoglycaemia, DKA and severe diabetes-related distress was at least halved, and HbA1c reduced by 0.7% (7mmol/mol) among those with highest baseline levels. Structured type 1 diabetes education delivered in routine practice offers clinically important benefits for those with greatest clinical need.

Health outcomes, quality improvement and cost-effectiveness of the Community Diabetes Education (CoDE) program: Results of a randomized controlled trial

The objectives of this dissertation were to evaluate health outcomes, quality improvement measures, and the long-term cost-effectiveness and impact on diabetes-related microvascular and macrovascular complications of a community health worker-led culturally tailored diabetes education and management intervention provided to uninsured Mexican Americans in an urban faith-based clinic. A prospective, randomized controlled repeated measures design was employed to compare the intervention effects between: (1) an intervention group (n=90) that participated in the Community Diabetes Education (CoDE) program along with usual medical care; and (2) a wait-listed comparison group (n=90) that received only usual medical care. Changes in hemoglobin A1c (HbA1c) and secondary outcomes (lipid status, blood pressure and body mass index) were assessed using linear mixed-models and an intention-to-treat approach. The CoDE group experienced greater reduction in HbA1c (-1.6%, p<.001) than the control group (-.9%, p<.001) over the 12 month study period. After adjusting for group-by-time interaction, antidiabetic medication use at baseline, changes made to the antidiabetic regime over the study period, duration of diabetes and baseline HbA1c, a statistically significant intervention effect on HbA1c (-.7%, p=.02) was observed for CoDE participants. Process and outcome quality measures were evaluated using multiple mixed-effects logistic regression models. Assessment of quality indicators revealed that the CoDE intervention group was significantly more likely to have received a dilated retinal examination than the control group, and 53% achieved a HbA1c below 7% compared with 38% of control group subjects. Long-term cost-effectiveness and impact on diabetes-related health outcomes were estimated through simulation modeling using the rigorously validated Archimedes Model. Over a 20 year time horizon, CoDE participants were forecasted to have less proliferative diabetic retinopathy, fewer foot ulcers, and reduced numbers of foot amputations than control group subjects who received usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life-year gained was estimated for CoDE intervention participants over the same time period. The results from the three areas of program evaluation: impact on short-term health outcomes, quantification of improvement in quality of diabetes care, and projection of long-term cost-effectiveness and impact on diabetes-related health outcomes provide evidence that a community health worker can be a valuable resource to reduce diabetes disparities for uninsured Mexican Americans. This evidence supports formal integration of community health workers as members of the diabetes care team.^

Teaching guides for diabetes education programs : selected annotations /

Mode of access: Internet.

Diabetic Mario: designing and evaluating mobile games for diabetes education

Traditionally, diabetes education has relied on written materials, with limited resources available for children with diabetes. Mobile games can be effective and motivating tools for the promotion of children's health. In our earlier work, we proposed a novel approach for designing computer games aimed at educating children with diabetes. In this article, we apply our game design to a mobile Android game (Mario Brothers). We also introduce four heuristics that are specifically designed for evaluating the mobile game, by adapting traditional usability heuristics. Results of a pilot study (n = 12) to evaluate gameplay over 1-week showed that the children found the game engaging and improved their knowledge of healthy diet and lifestyle.