Abstract
BackgroundDiabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care. They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and also the possible benefits or harm of the healthcare options. Therefore, we surveyed the CHC of diabetes educators.MethodsWe performed a cross-sectional survey using the validated Critical Health Competences (CHC) Test to measure CHC of certified diabetes educators and trainees in Germany. Diabetes educators were approached via newsletter, mailing lists or in person during the conference of the German Diabetes Association. Trainees were approached during their training sessions. We applied scenario 1 of the CHC test, which comprises 17 items with open-ended and multiple-choice questions. Mean person parameters with a range from 0 to 1000 were calculated to assess the levels of critical health competences and a multiple linear regression analysis was conducted to determine correlations between sociodemographic variables and levels of CHC.ResultsA total of 325 participants, mean age 38.6 (±11.1) years, completed the CHC test; n = 174 (55.5%) were certified diabetes educators and n = 151 (46.5%) were trainees. The participants achieved a mean score of 409.84 person parameters (±88.10) (scale from 0 to 1000). A statistically significant association was found only between the level of education and the level of CHC (b = 0.221; p-value 0.002). Participants with grammar school education achieved higher mean scores compared to participants with secondary school education (432.88 ± 77.72 vs. 396.45 ± 85.95; mean difference 36.42 ± 9.29; 95%CI 18.15 to 54.71; p < 0.0001).ConclusionDiabetes educators achieved low competence scores and it can be assumed that they do not have sufficient CHC to conduct consultations based on the SDM principles. Poor CHC among healthcare providers are a major barrier for the implementation of SDM. Core concepts of evidence-based medicine should be implemented into the curricula for diabetes educators in order to increase their levels of CHC.
Highlights
Diabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM)
Health authorities have highlighted the need to involve patients in the development and supply of healthcare, and request informed shared decision-making (SDM), where patients and healthcare providers simultaneously participate by sharing information and jointly negotiating the treatment options [6, 7]
Several barriers in the implementation of informed shared decision-making in clinical practice have been identified. Structural factors such as lack of time as well as a power imbalance in the relationship between the patient and the healthcare professional have been stated [10, 11]. Another major barrier is found in the poor critical health competences (CHC) among healthcare providers [12]
Summary
Diabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and the possible benefits or harm of the healthcare options. Several barriers in the implementation of informed shared decision-making in clinical practice have been identified Structural factors such as lack of time as well as a power imbalance in the relationship between the patient and the healthcare professional have been stated [10, 11]. Health literacy is a complex construct with different dimensions and it has been defined in multiple ways It concerns the motivation, knowledge and competences a person needs to understand, appraise and apply healthrelated information to improve their own health [14]. A high level of CHC can enhance patient autonomy with regard to therapeutic decisions
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