Diabetic patient education: determinants of success

Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions. These factors include targets set, self-management skills, influence of living with diabetes, emotional factors, role of other people, perceived benefits and barriers, feelings of self-efficacy, weight concern and diet barrier. Training in learning processes and factors governing behaviour are essential for all those involved in delivery of patient care. Educational programmes should recognise the wide range of learning strategies used by different people.     

A practical framework for encouraging and supporting positive behaviour change in diabetes

A wide range of diabetes‐directed interventions – including novel medications, devices and comprehensive education programmes – have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person‐centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment‐based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three‐step framework for organizing and describing the specific clinical processes involved is based on self‐determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.     

Patientenschulung in der Rheumatologie – eine Übersicht

Patient education is a medical intervention for patients with chronic diseases to increase knowledge of their disease, self-efficacy, self-management and consumer behaviour. The goal is to improve their disease outcome, social participation and quality of life. This article reviews concepts, modalities and knowledge on effectiveness of patient education. The results of different studies in different rheumatic diseases on efficacy will be summarized including a small number of cost-benefit analyses. Most studies report on significant and relevant improvements of knowledge, self-efficacy and health status. With respect to disease specific outcomes low to moderate effect sizes with a short duration have been observed. Especially good results have been reported when physical training or other methods of rehabilitation were included. There are marked improvements in consumer behaviour of health measures and sickness leave. A better understanding of information needs and baseline characteristics of patients is necessary to develop more appropriate educational interventions focussed on relevant outcomes that can be improved by educational measures.     

Four psychosocial theories and their application to patient education and clinical practice

Although the development of theoretically based and empirically verified practice guidelines is now possible, some health education practice still remains uninformed by this research-based knowledge. This article describes four psychosocial theories that have been useful in our practices: self-efficacy, stress and coping, learned helplessness, and social support. The theories are introduced and compared; practical suggestions for their use in the development of health education interventions are then discussed. Skills mastery, modeling, reinterpretation of physical signs and symptoms, and persuasion are presented as ways of enhancing self-efficacy. Some similar strategies are presented as examples of coping techniques, including positive reappraisal or reinterpretation. Other coping strategies such as confronting, distancing, self-care, seeking social support, accepting responsibility, escape avoidance or ignoring, problem solving, activity, distraction, self-talk, and prayer are also introduced. Cognitive restructuring is examined most fully as an example of an intervention strategy derived from learned helplessness theory. And finally, five strategies for fostering positive social support are presented: enhancing personal networks, linking volunteers, establishing mutual aid networks, identifying and supporting neighborhood helpers, and community empowerment.     

Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study

The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients' confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.     

Supporting self-management for people with hypertension: a meta-review of quantitative and qualitative systematic reviews

BackgroundThere is a growing call to integrate self-management support into health policies on chronic diseases. Self-management support (as proposed by the US Institute of Medicine) helps individuals “with medical management, role management and emotional management of their conditions”. Although the large burden of disease from hypertension makes any potential benefit from self-management support particularly important, it is unclear which interventions are effective for this asymptomatic disease. To inform policy and service provision, we undertook a mixed methods meta-review of quantitative and qualitative systematic reviews of self-management support interventions for hypertension.MethodsWe searched for English language publications in Medline, Embase, CINAHL, PsychINFO, AMED, BNI, DARE, and the Cochrane Database of Systematic Reviews (Jan 1, 1993, to Oct 1, 2012) and did manual, forward citation, and snowball searches. Search terms included “self-management support”, “hypertension”, and “systematic review”. We included systematic reviews of randomised controlled trials or qualitative studies of self-management support interventions that also included education and empowerment strategies (excluding mono-component interventions). We used R-AMSTAR to assess quality. Outcomes of interest (blood pressure and medication adherence) from the quantitative meta-review were synthesised narratively, and a meta-ethnographic analysis was done for the qualitative meta-review; the findings from the meta-review were then combined.Findings11 098 titles were screened, with two qualitative (57 unique studies) and ten quantitative reviews (151 unique studies) included. Interventions included technological, adherence, behavioural, and lifestyle support. Evidence was mixed, but no single intervention, combined with education, was clearly most effective. Some interventions, such as self-monitoring, were most beneficial when part of more complex interventions. The heterogeneity of interventions made evaluation of complex self-management support difficult; however, evidence suggested that it was the most promising type. Qualitative evidence demonstrated that people with hypertension might understand their condition differently from clinicians, frequently blaming stress and basing medication adherence on symptoms. Evidence suggested that partnership working is effective in enabling people's engagement with their condition and in overcoming conflicting perspectives.InterpretationThis mixed methods meta-review provides an overview of what works in self-management support interventions for hypertension and why, and will help inform hypertension policy. We suggest that services should acknowledge and incorporate patients' concerns and perspectives and work with them to use a variety of self-management support interventions that are tailored to individuals.FundingNational Institute for Health Services and Delivery Research programme (project number 11/1014/04).     

Sexual behaviour in context: a global perspective

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.     

Patient education for people living with diabetes in the Philippines: A scoping review of information needs,diabetes knowledge and effectiveness of educational interventions

Background and aimsDespite the growing burden of diabetes in the Philippines, available evidence indicates that its care and control are far from optimal, including patient education. The aim of this scoping review was to synthesize information in the available literature to describe the state of science of patient education for people living with diabetes in the Philippines, specific to educational needs, diabetes knowledge, and effectiveness of educational interventions.MethodsMedline, Embase, Emcare, CINAHL, Pubmed and American Psychological Association PsycInfo were searched from data inception through July 2021. Studies of any methodology (qualitative/quantitative/mixed methods), sample size, and language were eligible for inclusion.ResultsOf 2021 initial citations, 7 studies were included, with all being quantitative in design and with a median Critical Appraisal Skills Program score of 8/12. Information needs were described by one study and related to self-care abilities. Diabetes knowledge was measured in 6 studies and improved significantly after educational interventions. Overall, studies showed that educational interventions significantly impacted self-efficacy, anthropometric measures, hemoglobin A1c levels, utilization of care and routine programme and attitudes regarding their health.ConclusionsThe findings highlight the importance of a comprehensive and culturally appropriate educational intervention for this population. Further research is needed to develop such intervention and assess its effectiveness to change behaviour, such as increasing physical activity.     

"Sweet Talk": text messaging support for intensive insulin therapy for young people with diabetes

Optimal diabetes management involves considerable behavioural modification, while nonadherence contributes significantly to poor glycaemia. Extensive research on psychological interventions aiming to improve glycaemia suggests that current strategies are costly and time-consuming and in our experience do not appeal to young people with Type 1 diabetes. Text messaging has rapidly become a socially popular form of communication. It is personal, highly transportable, and widely used, particularly in the adolescent population. However, text messaging coupled with specific behavioural health strategies has yet to be utilised effectively. We have developed a novel support network ("Sweet Talk"), based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information. Individualised motivation strategies--based on social cognition theory, the health belief model, and goal setting--form the theoretical basis of the message content. Intensifying insulin therapy and increasing contact with the diabetes team can improve control, but are difficult to provide within existing resources. Our support system offers a means of contact and support between clinic visits and aims to increase adherence with intensive insulin regimens and to improve clinical outcome.     

自我效能在老年功能性消化不良患者社会支持和健康促进生活方式间的中介作用

背景自我效能和社会支持均能影响患者健康问题.目前对老年功能性消化不良(functional dyspepsia, FD)患者从自我效能和社会支持角度探索研究较少.因此本研究探讨老年FD患者的自我效能在社会支持,健康促进生活方式间的中介作用,为今后临床开展促进老年FD患者健康水平工作提供客观依据.目的探讨自我效能在老年FD患者社会支持和健康促进生活方式间的中介作用.方法选择2018-10/2019-10在浙江省金华市第二医院住院治疗的老年FD患者162例,采用一般自我效能问卷,社会支持量表及健康促进生活方式量表进行调查.结果老年FD患者社会支持总分为37.65分±6.58分,处于中度水平;一般自我效能感量表总分为27.62分±5.48分,属于中度水平;健康促进生活方式量表总分为120.85分±20.73分,处于一般水平.通过Pearson相关性分析表明,老年FD患者健康促进生活方式,社会支持及自我效能均呈正相关(P<0.05),社会支持总分,客观支持维度与一般自我效能呈正相关(P<0.01).以自我效能感作中介变量,社会支持作自变量,健康促进生活方式作因变量进行分层回归分析.中介效应估计值为0.458×0.384=0.175,占总效应之比为(0.458×0.384)/(0.458×0.384+0.431)=28.87%.结果表明,标准化回归系数均达显著水平(P<0.01),说明自我效能在老年FD患者社会支持和健康促进间具有中介作用.在多元线性回归分析基础上,采用非参百分位检验取样方法,取95%的置信区间使用Bootstrap法对自我效能感的中介效应进行检验,结果表明,自我效能感中介效应的95%的置信区间为0.115-0.223,P <0.05,说明自我效能感在社会支持和健康促进生活方式间起中介作用.结论老年FD患者社会支持,自我效能以及健康促进生活方式处于中等或一般水平;自我效能在社会支持与健康促进间起部分中介作用.所以,在临床工作中医护人员要加强老年FD患者的社会支持,提高患者自我效能,从而提升健康促进生活方式水平,改善患者健康情况.     

Changing office practice and health care systems to facilitate diabetes self-management

Diabetes is a self-managed disease for which patients provide 99% of their own care. For patients to succeed as diabetes self-managers, they need office practices and health care systems that can prepare and support them in their diabetes self-management efforts over the long term. In order to provide effective diabetes education and ongoing support, office practices and health care systems will have to fundamentally redefine the roles of health professionals and patients with diabetes, and redesign practices and systems to allow for effective long-term self-management education and support. Although it is difficult for both people and systems to change, change is essential if we are going to provide self-management support for the majority of patients suffering from this serious chronic disease.     

Global status of diabetes prevention and prospects for action: A consensus statement

Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high‐risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP‐1 agonists, glitazones, and acarbose, can be considered for selected high‐risk patients with prediabetes when lifestyle‐based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.     

Intensified multifactorial treatment of patients with Type 2 diabetes: What can be achieved and does it pay off?

By influencing the standards of diabetes care and treatment guidelines throughout the world, the results of recent long-term risk factor interventions in Type 2 diabetes (T2D) have likely contributed to the improved health outcomes and induced a decline in mortality in people with T2D. Although we have a need for even more evidence to support early, individualized, and intensive management of all known modifiable risk factors, we have now reached an era in T2D care where the critical challenges appear to be to translate the insights, knowledge and benefits to patients in the community setting. Current surveys show slow progress in achieving treatment goals and in the use of recommended drugs and adjustments of lifestyle for the prevention of vascular complications in diabetes. The resistance and barriers among medical professionals and patients likely have multiple causes. The present review focuses on experiences from multifactorial interventions in high-risk patients with T2D where it is possible to markedly improve their prognosis.     

Patient education in arthritis: helping people change

Systematic reviews of education for arthritis patients have emphasized behavioural approaches are effective in facilitating behaviour change and improving psychological and health status. This article discusses how a range of patient education and motivational approaches could be integrated into clinical practice to help people make behavioural changes to benefit their health. These include information giving, counselling, motivational interviewing, behaviour‐orientated self‐management therapy and cognitive–behavioural approaches. Copyright © 2003 Whurr Publishers Ltd.     

Sexual behaviour in young people

PURPOSE OF REVIEW: The purpose of this review was to synthesize major research findings in relation to young people and sexual behaviour from the period 2006-2007. RECENT FINDINGS: We found several key reviews that advance knowledge in the field of young people and sexual behaviour, including observational studies, both qualitative and quantitative, and intervention studies designed to reduce sexual transmission of HIV in both developed and developing countries. Other reviews focused on same-sex behaviours, victimization within relationships, HIV infection/sexually transmitted infection in travellers, prevention of HIV/sexually transmitted infection and the determinants of sexual behaviour in young people. SUMMARY: Powerful and consistent forces sustain gender differences in sexual behaviour. The design of interventions to reduce sexual risk behaviour should take account of these forces that help explain young people's sexual behaviour. Knowledge about the kind of interventions that reduce risk behaviour and should be implemented has improved, although the impact on health outcomes such as pregnancy and HIV/sexually transmitted infection is often uncertain. Effective school sex education needs to be part of much broader strategies to improve sexual health, and there is an urgent need for better evaluation of interventions, especially community interventions. Further longitudinal studies are needed to provide insight into the development of relationships and sexual behaviour as well as the course of acculturation.     

Lifestyle Intervention for the Prevention of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a serious, growing, and costly public health problem. The disease is chronic and degenerative, and thus primary prevention is desirable. Observational studies have linked type 2 diabetes to specific lifestyle behaviors. Several recent major clinical trials confirm that type 2 diabetes can be delayed or prevented in people at high risk; multicomponent lifestyle modification can reduce the incidence of diabetes up to 58%. The American Diabetes Association has recently recommended that lifestyle interventions to prevent or delay diabetes be delivered to people with prediabetes. Delivery of lifestyle interventions in practice is fraught with challenges, but there are several tools and practical strategies available for the implementation of trial findings.     

The use of structural equation modelling and behavioural theory to target priority interventions to increase condom use among the intimate partners of sex workers in French Guiana

French Guiana is the French overseas territory that is most affected by HIV. Sex work seems to be an important driver of the epidemic. Although female sex workers are informed by local NGOs, they still have risky behaviours, including not using condoms with their intimate partner despite knowing HIV is highly prevalent. The objective of this study was to find intervention targets on this specific behaviour. For this, a structural equation model (SEM) was built using assumptions from behavioural theories. Behaviour theories attempt to connect research and practice. Within the health belief model framework, perceived threats, perceived benefits, and self-perceived efficacy were tested. Vulnerability was added because of the particular context of French Guiana. The results highlight that female sex workers’ perceived self-efficacy was central in condom use with the intimate partner (with a significant correlation coefficient of 0.52 in the SEM). The perceived self-efficacy was strongly influenced by sociodemographic factors, particularly by nationality. Female sex workers from Brazil seemed to be more comfortable about asking their intimate partner to use condoms (OR: 7.81; CI: 1.87–32.63) than sex workers of other nationalities. These results emphasize that prevention interventions for female sex workers should emphasize their empowerment.     

The role of the certified diabetes educator in telephone counseling

PURPOSE: This paper describes a telephone-based, outcomes-focused approach to diabetes education provided by certified diabetes educators (CDEs). METHODS: Random chart audits were conducted to evaluate the scope of practice and effectiveness of telephone-based interventions provided by CDEs to people with diabetes. Four case studies and a sample prevention case are used to illustrate the role of telephone-based CDEs in providing diabetes education. RESULTS: Counseling provided by CDEs helped to identify potential barriers and strategies for making lifestyle behavioral changes. CONCLUSIONS: Telephone-based counseling is a brief, effective, ongoing intervention that gives patients with diabetes immediate access to CDEs who provide education to support lifestyle behavioral changes.     

Text Messaging Intervention for Teens and Young Adults With Diabetes

Adolescents and young adults use text messaging as their primary mode of communication, thus providing an opportunity to use this mode of communication for mobile health (mHealth) interventions. Youth with diabetes are an important group for these mHealth initiatives, as diabetes management requires an enormous amount of daily effort and this population has difficulty achieving optimal diabetes management. Goal setting and self-efficacy are 2 factors in the management of diabetes. We examined the feasibility of a healthy lifestyle text messaging program targeting self-efficacy and goal setting among adolescents and young adults with diabetes. Participants, ages 16-21, were assigned to either a text messaging group, which received daily motivational messages about nutrition and physical activity, or a control group, which received paper-based information about healthy lifestyle. Both groups set goals for nutrition and physical activity and completed a measure of self-efficacy. Participants’ mean age was 18.7 ± 1.6 years old, with diabetes duration of 10.0 ± 4.6 years, and A1c of 8.7 ± 1.7%. The text messaging intervention was rated highly and proved to be acceptable to participants. Self-efficacy, glycemic control, and body mass index did not change over the course of the short, 1-month pilot study. Positive, daily, motivational text messages may be effective in increasing motivation for small goal changes in the areas of nutrition and physical activity. These interventions may be used in the future in youth with diabetes to improve diabetes care. Utilizing more targeted text messages is an area for future research.