Diabetes Health Education Research Articles

Social media for diabetes health education - inclusive or exclusive?

Technological innovations are rising rapidly and are inevitably becoming part of the health care environment. Patients frequently access Social media as a forum for discussion of personal health issues; and healthcare providers are now considering ways of harnessing social media as a source of learning and teaching. This review highlights some of the complex issues of using social media as an opportunity for interaction between public- patient-healthcare staff; considers the impact of self- education and self-management for patients with diabetes, and explores some recent advances in delivering education for staff. When using any information technology, the emphasis should rely on being assessed rigorously to show it promotes health education safely, can be recognized as delivering up-to- date health information effectively, and should ensure there is no bias in selective communication, or disadvantage to isolated patient groups.

Effect of knowledge, attitude, belief, and practice model on self-care skills among elder patients with diabetic foot

Objective To explore the effect of knowledge , attitude, belief, and practice （ KABP ） model on self-care skills among elder patients with diabetic foot .Methods Seventy-seven elder patients were divided into the intervention group （ n=38 ） and control group （ n=39 ） .The KABP model was used in the intervention group , and the traditional teaching method was used in the control group .The patients were investigated with diabetic foot self-carequestionnaire and diabetic footself-efficacyscale （ DSES ） when they admitted into the hospital and after the intervention .Results The total score of self-care and DSES between the groups had no significant difference （ P 〉0.05 ）.After 3months intervention, the self-care score of the intervention group and the control group were （67.63 ±15.23） and （50.65 ±21.03）.The DSES score of the intervention group and the control group were （121.06 ±26.70） and （104.15 ±21.13）.There were significant differences between groups （t =18.298,18.016, respectively;P 〈0.01）.The self-care and DSES score compared before and after the intervention had significant differences （ P 〈0.01）.Conclusions Health education using the KAP model can efficiently enhance their self-care skills and diabetic foot self-efficacy. Key words: Elder patient Diabetic foot Health education Knowledge; attitude; belief; and practice model Self-care Self efficacy

Health and Diabetes Self-efficacy: A Study of Diabetic and Non-diabetic Free Clinic Patients and Family Members

Free clinics across the country provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. This study examined perceived health status among diabetic and non-diabetic free clinic patients and family members of the patients. Diabetes self-efficacy among diabetic free clinic patients was also investigated with the goal of developing appropriate diabetes health education programs to promote diabetes self-management. English or Spanish speaking patients and family members (N = 365) aged 18 years or older completed a self-administered survey. Physical and mental health and diabetes self-efficacy were measured using standardized instruments. Diabetic free clinic patients reported poorer physical and mental health and higher levels of dysfunction compared to non-diabetic free clinic patients and family members. Having a family history of diabetes and using emergency room or urgent care services were significant factors that affected health and dysfunction among diabetic and non-diabetes free clinic patients and family members. Diabetic free clinic patients need to receive services not only for diabetes, but also for overall health and dysfunction issues. Diabetes educational programs for free clinic patients should include a component to increase diabetes empowerment as well as the knowledge of treatment and management of diabetes. Non-diabetic patients and family members who have a family history of diabetes should also participate in diabetes education. Family members of free clinic patients need help to support a diabetic family member or with diabetes prevention.

Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses

This study examined the differing perceptions of diabetic patients and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patient’s educational needs to promote better health care for patients with diabetes in Taiwan. This study employed a cross-sectional survey. The data were collected during 2009. Questionnaires were developed to collect data on a convenience sample of 312 patients with type 2 diabetes and 202 nurses recruited from diabetes clinics in Taiwan. Perceptions of self-care behavior were statistically significantly different between patients and nurses (t = –5.05, P < 0.000). The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful at completing self-care tasks. Nurses perceived patients to experience greater difficulties in diabetes health education (t = 18.36, P < 0.000). Nurses perceived there to be a greater need for health education as compared with patients (t = 9.03, P < 0.000).

Assessment of knowledge about the role of diet regime and physical exercise to control diabetes among type 2 diabetic patients in Khartoum State, Sudan

Background: Non-communicable diseases, particularly diabetes mellitus, represent a global worldwide threat, being highly prevalent and cause a wide range of disabilities, morbidity and mortality. Aims & Objective: The objective of the study was to explore knowledge about the role of diet regime and physical exercise to control diabetes among Sudanese type 2 diabetic patients in Khartoum State and determine factors associated with it. Materials and Methods: This was a cross-sectional health facility-based study. Using a modified Diabetes Care Profile questionnaire, type 2 diabetic patients of more than 18 years of age and having diabetes for at least 1 year attending two selected specialized diabetic care centers and one endocrinology referred clinic were interviewed. The study sample was 306. Data was analyzed using SPSS software. Results: A total of 310 patients were enrolled, of whom 289 patients were interviewed. Mean age was around 55 years and 54% were females. The proportions found to have excellent knowledge levels about diet regime were 62.3%; about physical exercise were 51.2%. Self-care knowledge levels were found to be significantly associated with age, educational level, being employed, and having health education about DM before. Conclusion: Diabetes health education and social support are important determinants of diabetes self-care related knowledge. Strategies should focus on training of physicians and health-care providers on all aspects of diabetes-related knowledge. Efforts are needed to improve the socioeconomic status of diabetics and educate them for better control of the disease.

Knowledge about risk factors, symptoms and complications of diabetes among adults in South India

Background: Diabetes is a major public health problem in India. However, awareness on diabetes is still remaining challenges in Indian population. This study aimed to assess the knowledge about risk factors, symptoms and complications of diabetes and its association with socio demographic factors. Methods: The study was carried out at Neelambur, south India. A total of 500 adults were randomly selected and interviewed using a pretested specifically designed questionnaire. Results: Of 500 participants interviewed, 42.4% perceived high consumption of sugar as an important risk factor for developing diabetes. Only 54.4%, 47.8%, 58.4%, 53.6% and 45.4% perceived presence of family history of diabetes, obesity, increasing age, physical inactivity and stress as risk factors for diabetes. Majority of them felt slow healing of wound as a symptom for diabetes, but feeling of thirst, frequent urination and tiredness as a symptom for diabetes were identified by only 58.6%, 73.8%, and 73.8% respectively. Only 59.6% of participants understood that diabetes could produce complications. A higher education and presence of family history of diabetes were found to be positively associated with more diabetes knowledge. Conclusion: This study highlights that there is lack of awareness of major risk factors for diabetes. Level of education and presence of family history of diabetes are the most significant factors associated with knowledge regarding risk factors, symptoms and complications of diabetes. Massive diabetes health education programs are urgently needed in this population.

Diabetes self-management education in a high-income developing country: survey of the opinion of nurses and dietitians

To assess the views of nurses and dietitians on diabetes self-management education and the preparedness of their work places for implementing diabetes self-care. 1,057 (71 %) of the estimated 1,498 qualified nurses and dietitians employed in the services of the Regional Health Authorities between November 2011 and April 2012 completed the self-administered research questionnaire previously pre-tested on a cohort of student nurses. The questionnaires did not contain any personal identifiers but were serially numbered to avoid receiving duplicate copies from a participant. The questionnaires were distributed to all public hospitals and health centres within the regional health authorities. The head nurse in each facility assisted in the distribution and collection of completed questionnaires from the volunteers. One thousand thirty-two nurses and 25 dietitians participated in the study. While the majorities of the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, 68 % and 58 % of them respectively did not think that there was adequate diabetes health education for the patients in their places of work. Furthermore, 73 % of the nurses and dietitians think that the health care system was not prepared for diabetes self-management education given that there were not enough qualified health personnel, educational facilities and economic resources. Although the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, inadequate healthcare personnel, economic resources and educational facilities constitute significant barriers. We recommend that governments in the developing countries should invest human and material resources into healthcare education.

Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses.

Abstract This study examined the differing perceptions of diabetic patients and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patients' educational needs to promote better health care for patients with diabetes in Taiwan. This study employed a cross-sectional survey. The data were collected during 2009. Questionnaires were developed to collect data on a convenience sample of 312 patients with type 2 diabetes and 202 nurses recruited from diabetes clinics in Taiwan. Perceptions of self-care behavior were statistically significantly different between patients and nurses (t=-5.05, P<0.000). The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful at completing self-care tasks. Nurses perceived patients to experience greater difficulties in diabetes health education (t=18.36, P<0.000). Nurses perceived there to be a greater need for health education as compared with patients (t=9.03, P<0.000).

Self‐efficacy, self‐care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross‐sectional survey

The relationships between self-efficacy, self-care behavior, anxiety, and depression for Taiwanese individuals with type 2 diabetes were determined in this study. Depression and anxiety are common symptoms that can contribute toward adverse medical outcomes. A descriptive, cross-sectional, correlational design was used. The sample comprised 201 patients with type 2 diabetes from diabetes outpatient clinics at three teaching hospitals in Taiwan. The results of this study revealed that people with diabetes who had received diabetes health education, regularly made clinical visits, underwent treatment, and did not smoke demonstrated a high self-efficacy score (P < 0.05). Self-efficacy among people with diabetes positively correlated with illness duration (P < 0.05), treatment (P < 0.01), and self-care behavior (P < 0.01). Self-efficacy among people with diabetes negatively correlated with anxiety and depression (P < 0.01). Self-efficacy can be a predictor of anxiety and depression (P < 0.01). This study revealed that enhancing self-efficacy levels might reduce anxiety and depression. Self-efficacy-enhancing programs should be held regularly in clinical practices. Conducting psychological research on diabetes drives policy and healthcare system change.

Influence of diabetes educators in diabetic patients' health education

Objective To investigate the important role of diabetes educators in diabetic patients'health education process.Methods A total of 73 diabetic patients were evaluated by the same self-designed questionnaire before and after health education by diabetes educators,and the results were compared.Results After health education,the rate of 73 diabetic patients' diet knowledge including total calorie,amount of staple food,non-staple food,oil,vegetable and fruit were respectively 90.4％,97.3％,98.6％,98.6％,98.6％ and 95.9％,all of which were higher than those before health education (26.0％,78.1％,68.5％,42.5％,58.9％ and 71.2％),and the differences were statistically significant (x2 =43.31,12.25,20.17,39.09,29.12,14.73,respectively; P ＜ 0.01).After the diabetes health education,the rate of 73 diabetic patients' insulin types knowledge was 64.4％,was higher than this before health education (45.2％),the difference was statistically significant (x2 =10.29,P ＜ 0.01).The rate of patients' self-monitoring behaviors including keeping a diary,recording special events,measuring blood pressure weekly,testing HbA1 c every three months,doing fundus examination at regular intervals and inspecting blood fat,liver and kidney function regularly after health education were respectively 91.8％,98.6％,98.6％,98.6％,98.6％ and 98.6％,obviously higher than those before education (32.9％,24.7％,46.6％,39.7％,50.7％ and 54.8％),and the differences were statistically significant (x2 =39.34,52.07,36.10,41.09,33.11,30.11,respectively; P ＜0.01).Conclusions The diabetes educators play an important role in improving diabetes patients' level of healthy knowledge. Key words: Diabetes; Health education; Diabetes educator; Rate of knowledge

Socio-Economic Status and Hemoglobin Concentration of Type 2 Diabetes Mellitus Patients Attending Diabetic Clinic in Benin City, Nigeria

The aim of this study is to determine the Socio Economic Status and Red Blood Cell Hemoglobin concentration alteration in type 2 Diabetes mellitus patients attending Diabetic Clinic in Benin City, Nigeria. The sample population consists of 142 subjects, 71 of patients were known in Type 2 Diabetes mellitus already on drugs and were confirmed to be Diabetic using Glucose oxidase method while the other 71 subjects were age matched apparently healthy control subject on routine check up, they were confirmed to be non Diabetic using the Glucose oxidase method. Hemoglobin concentrations were done using the Cyanmethemoglobin method. Those under the low income Socio-Economic status had the highest incidence of type 2 Diabetes mellitus (49%) of the Diabetic population, closely followed by the middle income Socio-Economic status (35%) of the Diabetic populations. The Mean ± S.D of Hemoglobin concentration of control subjects against Mean ± S.D of Hemoglobin concentration of the various Socio-Economic status of Males and Females type 2 Diabetes mellitus patient show a statistically significant decrease (P < 0.05). Type 2 Diabetes mellitus is associated with Anemia irrespective of Socio-Economic status. Prevention of the Global Diabetes epidemic must include regular national surveys, introduction of Diabetes health education in schools, emphasis on balance diet, regular exercise and abstention from tobacco smoking.

Public knowledge of diabetes in Karen Ethnic rural residents: a community-based questionnaires study in the far north-west of Thailand

Background and purposeThe public knowledge of diabetes is important for prevention of disease. This study aimed to evaluate knowledge of diabetes, risk factors, and the common warning signs of diabetes and complications among community participants in a rural Karen ethnic community.MethodsParticipants were asked to answer a questionnaire regarding their knowledge of diabetes. Fasting blood glucose testing, blood pressure measurement, and body mass index (BMI) assessment were provided to the participants. The study was conducted at Thasongyang district, Tak province, Thailand.ResultsA total of 299 Karen rural residents were included in the study. The median age was 45 years and median fasting blood glucose was 88 mg/dL. The response rate to the questionnaires was 91.97%. Half of the participants knew diabetes is a noncommunicable disease needing lifelong treatment. Overall, one-third of the community participants could correctly answer the knowledge assessment questions regarding risk factors and common features of diabetes. whereas the other two-thirds either gave a wrong answer or were “not sure”. Female participants had poorer diabetes knowledge than the males.ConclusionThe public knowledge of diabetes, as represented by this sample of the Karen ethic community, is alarmingly low. There is significant gender difference in knowledge level. Culturally tailored and gender-sensitive diabetes health education interventions are urgently needed in this minority ethnic community.

An innovative multiphased strategy to recruit underserved adults into a randomized trial of a community-based diabetes risk reduction program.

To conduct and evaluate a two-phased community-based approach to recruit lower socioeconomic status, minority, or Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle intervention program delivered by a public health department. Within geographic areas comprising our target population, 4 community organizations provided local space for conducting the study and program. Phase I-outreach in venues surrounding these organizations-included diabetes education, a short diabetes risk appraisal (DRA), and diabetes risk screening based on a fasting fingerstick glucose test. Phase II-trial recruitment-began concurrently for those found to be at risk of developing diabetes in Phase I by explaining the study, lifestyle program, and research process. Those interested and eligible enrolled in the 1-year study. Over 2 years, approximately 5,110 individuals received diabetes education, 1,917 completed a DRA, and 1,164 were screened of which 641 (55%) had an elevated fingerstick result of ≥ 106 mg/dl. Of the study sampling frame-persons over age 25 at risk of developing diabetes (N = 544)-238 (43%) enrolled in the trial; of those who were study eligible (n = 427), 56% enrolled. In the final sample, mean age was 56 years (SD = 17), 78% were ethnic minorities, 32% were Spanish-speaking, and 15% had a high school education or less. Providing diabetes health education and screening prior to study recruitment may help overcome barriers to research participation in underserved communities, thus helping address difficulties recruiting minority and older populations into research, particularly research pertaining to chronic disease risk factors.

Feasibility and Effectiveness of a Pilot Health Promotion Program for Adults With Type 2 Diabetes

The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness. Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 +/- 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (alpha = .05). Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy. A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy.

Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials

To determine if culturally appropriate health education is more effective than 'usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA(1c), blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA(1c) showed an improvement at 3 months [weighted mean difference (WMD) -0.32%, 95% confidence interval (CI) -0.63, -0.01] and 6 months post intervention (WMD -0.60%, 95% CI -0.85, -0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than 'usual' health education in improving HbA(1c) and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research.

Effectiveness of Diabetes Educational Interventions in Iran: A Systematic Review

Education of patients with diabetes is considered a fundamental aspect of diabetes care and aims to empower patients by improving knowledge and skills. The aim of this study was to conduct a systematic review of reports published about educational interventions on Iranian patients with diabetes. All published articles in Iranian and international journals and those presented in relevant congresses were reviewed using standard key words. Studies published from April 2002 to December 2008 that met the eligibility criteria were included for this systematic review. A total of 18 discrete studies were identified. These studies were heterogeneous with respect to patient population, educational intervention, outcomes assessed, study quality, and generalizability. However, positive effects of self-management training on knowledge, frequency, and accuracy of self-monitoring of blood glucose and glycemic control were demonstrated in studies with short follow-up (less than 6 months). Effects of interventions on lipids, nutritional diet, weight, blood pressure, and quality of life were variable. There are insufficient and conflicting findings to obtain any firm conclusions regarding diabetes education in Iran. However, the appropriate diabetes health education appears to have short-term effects on glycemic control and knowledge of diabetes. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, more rigorous methodology. It is also highly recommended to health policy makers in Iran that a special course for training diabetes educators be designed because it would enable them to tailor appropriate education intervention for people with diabetes.

The status and perspective of diabetes health education in China: Inspiration from Australia

This paper discusses possible approaches to improving diabetes care and developing effective education models in China based on the experience of diabetes education in Australia. The prevalence of diabetes mellitus in China is increasing rapidly. China is currently second on the list of the top 10 countries with the highest diabetes burden. Enormous impact of diabetes on China health system is daunting and the urgent action is needed. Diabetes education is the keystone of diabetes care and structured self-management education is considered to be the key to successful outcomes. Although many diabetes education programmes have been initiated in China, barriers have been identified for implementation of the programmes. These include: lack of public awareness of diabetes; lack of standards of practice for diabetes educators; and lack of evaluation programmes to assess their performance. We suggest four possible approaches to addressing the current problems of diabetes education in China.

The related factors of influencing the compliance of diabetes mellitus patients

Objective To discuss the related factors which influence the compliance of diabetes mellitus patients. Methods Questionnaire investigation method and self designed chart were used to random investigate 100 diabetes mellitus patients (including clinic and inpatient) according to WHO diagnose standard Results There was a bad cure compliance among old people, peasant, lower education and lower income, less knowledge of disease, wrong health ideas and no any health education persons. Conclusions There is a relationship between cure compliance and age, occupation, education, knowledge of diabetes mellitus, health ideas and health education factors. Good or bad cure compliance depends on the control of blood sugar and complication. Health educations can enhance patient care compliances and care effect as well. Key words: Diabetes mellitus; Cure compliance; Related factor

Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomised controlled trials.

Diabet. Med. 27, 613–623 (2010) Abstract To determine if culturally appropriate health education is more effective than ‘usual’ health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA1c, blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA1c showed an improvement at 3 months [weighted mean difference (WMD) −0.32%, 95% confidence interval (CI) −0.63, −0.01] and 6 months post intervention (WMD −0.60%, 95% CI −0.85, −0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than ‘usual’ health education in improving HbA1c and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research.

Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil

Diabetes is a significant public health burden on the basis of its increased incidence, morbidity, and mortality. This study aimed to estimate the prevalence of inadequate glycaemic control and its correlates in a large multicentre survey of Brazilian patients with diabetes. A cross-sectional study was conducted in a consecutive sample of patients aged 18 years or older with either type 1 or type 2 diabetes, attending health centres located in ten large cities in Brazil (response rate = 84%). Information about diabetes, current medications, complications, diet, and satisfaction with treatment were obtained by trained interviewers, using a standardized questionnaire. Glycated haemoglobin (HbA1c) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA1c ≥ 7 were considered to have inadequate glycaemic control. Overall 6,701 patients were surveyed, 979 (15%) with type 1 and 5,692 (85%) with type 2 diabetes. The prevalence of inadequate glycaemic control was 76%. Poor glycaemic control was more common in patients with type 1 diabetes (90%) than in those with type 2 (73%), P < 0.001. Characteristics significantly associated with improved glycaemic control included: fewer years of diabetes duration, multi professional care, participation in a diabetes health education program, and satisfaction with current diabetes treatment. Despite increased awareness of the benefits of tight glycaemic control, we found that few diabetic patients in Brazil met recommended glycaemic control targets. This may contribute to increased rates of diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.