Group Education Program Research Articles

Living with Diabetes: an educational model of care for new onset diabetes

AbstractThe first year following diagnosis is a critical time for those newly diagnosed with type 1 diabetes and is likely to influence long‐term glycaemic control.This paper describes a group education programme, Living with Diabetes (LwD), and reports the outcome data at one year and three years after diagnosis. HbA1c was compared with outcomes from the cohort diagnosed during the four years prior to the inception of LwD.We have demonstrated that, in terms of HbA1c, the programme achieved outcomes similar to the traditional model with similar staff resources. The LwD pathway required an additional 2.9 hours per patient but HbA1c values were consistently lower in those who attended all sessions.The data suggest the need for more concerted attention to engage patients in an ongoing care pathway during the early years following diagnosis. An evaluation of the programme suggested that patients valued the relaxed non‐hierarchical nature of the group and the opportunity to share with and ask questions of their peers. Copyright © 2013 John Wiley & Sons.

Radiographic assessment of the severity of thumb carpometacarpal osteoarthritis in the dominant and non-dominant hand: a descriptive, cross-sectional study

a. Purpose: thumb carpometacarpal osteoarthritis is a disabling condition that can lead to pain at the base of the thumb and impairment of hand function. Considering that usage of the hand is within the risk factors for hand osteoarthritis and that the dominant hand is more demanded in occupational activities, especially during tasks that require precision pinches, the purpose of this study was to compare the radiographic changes at the carpometacarpal (CMC) thumb in the dominant and non-dominant hand. b. Methods: we studied 108 (19 male and 89 female) subjects, between 40 and 80 years old, with radiographic changes of the thumb CMC joint. The individuals represented 65% of the participants enrolled in a group education programme for patients with knee osteoarthritis (OA) in the Institute of Orthopaedics and Traumatology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Patterns of the use of the hand was varied among the subjects, including occupations such as housekeepers, secretaries, seamstress, teachers, nursing assistants, workers of metallurgical plant, etc. Two orthopedic surgeons assessed bilateral thumb CMC joint radiographs according to Kellgren and Lawrence (KL) scale. The participants were asked by telephone call or in their follow up visit which was their dominant hand and what was the main occupational activity they did most during the last years. We examined the data for correlation between the grades of severity of osteoarthritis in the thumb CMC, handedness and occupational usage of the hand. c. Results: 25% (95% CI: 18-33) of the 108 subjects had a higher KL grade in the thumb CMC of the dominant hand comparing with the non-dominant (dominant KL mean: 2; non-dominant KL mean: 0,75; range1 to 4) ; 18% (95% CI:10-25) had a higher KL grade in the thumb CMC of the non-dominant hand (non-dominant KL mean: 2,35; dominant KL mean: 1; range 1 to 4); and 55% (95% CI: 45-64) had no difference in the severity of the thumb CMC comparing the dominant with non-dominant hand (KL mean 1,7; range 1-4). We did not find an association between occupational use of the hand and severity OA of the thumb CMC joint because there were too many subgroups of occupational activities and patterns of use of the hand. d. Conclusion: The results suggest that there is no association between joint destruction and the overuse of the thumb CMC of the dominant hand comparing with the non-dominant hand in individuals with thumb CMC and knee osteoarthritis. In this sense, our initial hypothesis seems to be not true. Comparison and analysis of pain and hand function in dominant and non-dominant hand will possibly show different findings. Correlation between occupational use of the hand (work activities) and thumb CMC severity OA should be done with a bigger or more homogenous sample.

Effect of a Group Intervention to Promote Older Adults’ Adjustment to Driving Cessation on Community Mobility: A Randomized Controlled Trial

The UQDRIVE program, a group education and support program, was developed to meet the needs associated with driving cessation for older adults. The current study investigated the effect of the program on community mobility. A prospective, parallel, stratified randomized controlled trial was undertaken with a waitlist control group receiving current clinical practice (no intervention). Data were collected pre, post, and 3 months following the intervention. Participants were adults aged 60 years or older who had ceased driving or planned to cease driving within 12 months. A total of 131 participants were included in analyses (67 intervention, 64 control). Participating in the intervention was significantly associated with a higher number of episodes away from home per week at immediately postintervention (z = 2.56, p = .01). This was not significantly maintained at 3-month follow-up. Participation in the intervention also significantly predicted higher use of public transport at immediately postintervention (z = 2.12, p = .034), higher use of walking at immediately postintervention (z = 2.69, p = .007), increased aspects of community mobility self-efficacy (z = 3.81, p = .0001), and higher satisfaction with transport at 3-month follow-up (z = 2.07, p = .038). The program increased community mobility immediately postintervention and transport satisfaction at 3 months postintervention. Due to a high attrition rate, further research is required to clarify the long-term impact of the intervention.

‘Changing Habits’: an evaluation of a dual diagnosis focused, integrated, multimodal, psychosocial education and skill building group programme delivered in a community-based setting

Over the past decade the evidence for the effectiveness of integrated treatment for people with co-occurring mental health and substance use problems has continued to expand. Yet there is still a paucity of evidence for which specific types of treatment interventions are effective for this client population. There is some emerging evidence for the effectiveness of group-based psychosocial interventions. The aim of the study was to assess the effectiveness of an integrated psychosocial education and skill building group programme designed for people with co-occurring mental health and substance use problems. Assessment of pre-, mid- and post-group changes for participants of the programme using quantitative and qualitative outcome measures for some aspects of mental health and substance use was carried out. Participation in the programme resulted in significant improvements in depression, anxiety, stress and self-esteem. Motivation for making changes to substance use was enhanced and while the quantitative...

Minibus taxi drivers’ sexual beliefs and practices associated with HIV infection and AIDS in KwaZulu- Natal, South Africa

Risky sexual behaviours in South Africa are a major contributing factor to the spread of HIV infection and AIDS. HIV infection amongst minibus taxi drivers is a concern, because these people belong to an occupational group that exhibits risky behaviours due to the demands of their work. Given the high vulnerability of minibus taxi drivers, exploring the sexual beliefs and health-related sexual practices of this group will assist in planning targeted interventions. The objectives of this study were to assess the level of knowledge, beliefs and practices regarding HIV infection and AIDS amongst minibus taxi drivers. An exploratory descriptive study was conducted using a pre-tested questionnaire to explore and describe sexual beliefs and practices associated with HIV infection and AIDS in a convenience sample of 175 minibus taxi drivers. Permission to undertake the study was obtained from the KwaZulu-Natal Taxi Alliance and individuals who participated in the study. Data analysis were analysed using the Statistical Package for Social Sciences 13.0. The study revealed that minibus taxi drivers are one of the high- risk groups in the spread of HIV infection and AIDS; they lack necessary education and need attention in relation to control and prevention of the spread of HIV and AIDS. Multiple sexual partners are relatively common amongst the minibus taxi drivers. Violence against women and even forceful sexual intercourse in the belief that women should tolerate it to keep the family together was reported. There is a need for intervention programmes with a focus on minibus taxi drivers and similar high-risk groups. Prevention activities should incorporate the distribution of condoms amongst this group and HIV prevention educational programmes, as well as creating mechanisms for accessing circumcision by the minibus taxi drivers.

A role of individual educational programs for asthma control

Summary. Sixty patients aged 18 to 60 years with bronchial asthma (BA) were examined. Clinical and psychological state was evaluated before and 1 month after an educational course. Implementation of individual education programs has led to a reliable increase in compliance and asthma control and in clinical and psychological improvement in comparison with BA patients involved in group education programs. Thus, the individual education programs allow increasing the efficiency of therapeutic and preventive measures in BA patients.

The comprehensibility of health education programs: Questionnaire development and results in patients with chronic musculoskeletal diseases

ObjectiveThe objective was to develop a comprehensive questionnaire for measuring the patient-perceived comprehensibility of health education programs (COHEP questionnaire). According to a conceptual model outlined in the article, comprehensibility is considered a context factor of patient health literacy. MethodsA questionnaire study was carried out on N=577 patients with chronic musculoskeletal diseases. During inpatient rehabilitation, patients participated in standardized, interactive group education programs conducted by clinic personnel. Factorial structure, unidimensionality, reliability, fit to the Rasch model, and construct validity were tested. ResultsThe COHEP consists of 30 items and 4 scales (comprehension-fostering behavior of program trainers, transferability to everyday life, comprehensibility of medical information, amount of information). All scales are reliable, unidimensional, and meet the requirements of the Rasch model. In addition, there are initial indications of validity. The descriptive results show that the overall rating of the comprehensibility of patient education programs in the German rehabilitation system is good, but that there are clear differences between centers. ConclusionThe COHEP can be used to evaluate health education programs, since it measures an important proximal outcome. Practice implicationsAn analysis of patient-perceived comprehensibility can help providers adapt education sessions better to the health literacy of patients.

Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes.

To evaluate the effectiveness of a family-centred group education programme, in adolescents with Type 1 diabetes. Three hundred and five adolescents with Type 1 diabetes; age 13.1 ± 1.9 years, diabetes duration 5.6 ± 3.3 years, BMI 20.9 ± 3.7 kg/m(2) , HbA(1c) 78 ± 6 mmol/mol (9.3 ± 1.9%) were randomly allocated to the Families and Adolescents Communication and Teamwork Study (FACTS) diabetes education programme; (six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork) or conventional clinical care. Primary outcome was HbA(1c) at 18 months (12 months post-intervention). Secondary outcomes were HbA(1c) at 9 months, psychosocial outcomes, adolescent quality of life, well-being, family responsibility and insulin dose adjustment behaviours at 12 months (6 months post-intervention) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention. All analyses are intention to treat. Session attendance was poor with 48/158 families (30.4%) not attending any sessions and only 75/158 (47.5%) families attending ≥ 4 group education sessions. All biomedical and psychosocial outcomes were comparable between groups. At 18 months there was no significant difference in HbA(1c) in either group and no between-group differences over time: intervention group 75 mmol/mol (9.0%) to 78 mmol/mol (9.3%), control group 77 mmol/mol (9.2%) to 80 mmol/mol (9.5%). Adolescents perceived no changes in parental input at 12 months. Poor attendance of group education sessions delivered in routine clinics was a major challenge. More personalized educational approaches may be required to support and motivate families who are struggling to integrate the demands of intensive insulin regimens into their daily lives.

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

BackgroundThe Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.MethodsThis study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.ResultsThe results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.ConclusionsDespite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.

A Systematic Review of Education for the Prevention of HIV/AIDS among Older Adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.

The role of group education on quality of life in patients with a stoma

Stoma education has been traditionally given in a one-to-one setting. Since 2007, daily group education programmes were organised for stoma patients and their relatives by our stoma therapy unit. The programmes included lectures on stoma and stoma care, and social activities in which patients shared their experiences with each other. Patients were also encouraged to expand interaction with each other and organise future social events. A total of 72 patients [44 (61.1%) male with a mean (± SD) age of 56.8 ± 13.6 years] with an ileostomy (n= 51, 70.8%), a colostomy (n= 18, 25.0%) or a urostomy (n= 3, 4.2%) were included in the study. Patients were asked to answer a survey (SF-36) face-to-face before the initiation of the programme, which was repeated 3 months later via telephone call. The comparison of pre-education and post-education SF-36 scores revealed a statistically significant improvement in all 8-scale profiles, but not in vitality scale, and both psychometrically-based and mental health summary measures. Analyses disclosed that married patients and those who were living at rural districts seem to have the most improvement in life quality particularly in bodily pain, general health and role-emotional scales and mental health summary measure. In our opinion, group educations may be beneficial for stoma patients, and stoma therapy units may consider organising similar activities.

Advance care planning and pulmonary rehabilitation: participation and patient perspectives

Patients attending pulmonary rehabilitation generally have moderate to severe lung disease and are at increased risk for life threatening cardio-respiratory events. Enabling people with chronic lung disease to make informed...

Leicester Foundation Group: successful implementation of structured education for newly‐diagnosed type 1 diabetes

AbstractIn the UK there are currently no national structured education programmes for people newly diagnosed with type 1 diabetes. In Leicester we developed a programme for people to attend within six months of diagnosis with the aim of increasing patients' self‐efficacy in managing their diabetes.Forty‐two people attended the group over a 12‐month period. The participants completed a questionnaire based on a 10‐point Likert scale to assess confidence to participate in daily activities while managing their insulin and blood glucose levels, both at baseline and after the structured education intervention.Participants self‐reported improved confidence levels aligned to different situations, including the ability to adjust insulin accordingly and achieve target blood glucose (4–7mmol/L). Scores increased significantly in a number of scenarios, e.g. confidence to do a sporting activity 8(6.5–8.2) to 9(8.0–9.0), confidence to adjust insulin for the activity 5(3.8–6.2) to 8(6.9–8.3), and confidence that glucose levels will be in target after insulin adjustment 4(3.4–5.6) to 8(6.6–8.0).Attendance at a structured group education programme can significantly increase individuals' self‐efficacy to manage type 1 diabetes. Copyright © 2012 John Wiley & Sons.

Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care

Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years.Design Three...

Supporting family caregivers of hospitalised palliative care patients: a psychoeducational group intervention

BackgroundMany family caregivers of palliative care patients experience poor health and have other unmet needs, requiring health professionals' support. However, there are few evidence-based supportive interventions to address these issues.PurposeThe...

Psycho-Educational Group Intervention for Family Caregivers of Hospitalized Palliative Care Patients: Pilot Study

Family caregivers of patients requiring palliative care commonly experience physical, social, and psychological burdens. Although family caregivers are acknowledged as valid service recipients of palliative care, many have unmet needs, and systematic reviews have shown there are limited evidence-based supportive interventions. This study aimed to develop and pilot test a psycho-educational group education program delivered in the inpatient specialist palliative care setting and designed to prepare primary family caregivers for the role of supporting a relative receiving hospital-based palliative care. (1) Development of education session and delivery protocol by the research team and expert panel; (2) pilot the intervention in three clinical sites (five sessions in total); (3) evaluate its accessibility and acceptability; and (4) preliminary testing of outcome measures used to access the intervention's effectiveness. The results revealed that the intervention was appropriate and acceptable to caregivers. The intervention needs to be tested in a larger sample to determine the potential benefits for caregivers' sense of preparedness and competence, and testing needs to ascertain if the intervention is accessible.

The Complementary Medicine Education and Outcomes (CAMEO) program: A foundation for patient and health professional education and decision support programs

ObjectiveThis paper describes the background, design and evaluation of a theory-informed education and decision support program for cancer patients considering complementary medicine (CM). MethodsThe program was informed by the Shared Decision Making theory, the Ottawa Decision Support Framework and the Supportive Care Framework. Previous empirical evidence and baseline research were used to identify patients’ and health professionals’ (HPs) information and decision support needs related to CM. ResultsTo address the continuum of CM needs, a variety of education and decision support interventions were developed, including basic CM information and resources for patients and HPs, a group education program and one-on-one decision support coaching for patients, and an on-line education module for HPs. Evaluation of the program and individual interventions is underway. ConclusionsThis education and decision support program addresses a significant gap in care and offers an evidence-informed framework in which to translate CM evidence to conventional care settings and promote communication about CM. Practice implicationsEvidence-informed CM education and decision support interventions are needed to shift the culture around CM within conventional care settings and promote open communication that will lead to CM therapies being safely integrated into care.

Self-care 3 months after attending chronic obstructive pulmonary disease patient education: a qualitative descriptive analysis

PurposeThe authors performed a qualitative descriptive analysis to explore how group patient education influences the self-care of patients with chronic obstructive pulmonary disease.Patients and methodsIn the period 2009–2010, eleven patients diagnosed with chronic obstructive pulmonary disease completed an 8-week group education program in a Danish community health center. The patients were interviewed 3 months after completion of the program.FindingsPatients reported that their knowledge of chronic obstructive pulmonary disease had increased, that they had acquired tools to handle their symptoms, and that the social aspect of patient education had motivated them to utilize their new habits after finishing the course. The data indicate that patients need a period of adjustment (a “ripening period”): it took time for patients to integrate new habits and competencies into everyday life. Talking to health care professionals focused the patients’ attention on their newly acquired skills and the research interview made them more aware of their enhanced self-care.ConclusionPatients’ self-care may be enhanced through group education, even though the patients are not always able to see the immediate outcome. Some patients may require professional help to implement their newly acquired knowledge and skills in everyday life. A planned dialogue concentrating on self-care in everyday life 3 months after finishing the course may enhance patients’ awareness and appraisal of their newly acquired competencies.

Self-Help Education as Outreach Program for Osteoarthritis Patients in Rural Korea

Purpose: This study was done to determine if osteoarthritis (OA) patients living in rural Korea would have a benefit from a structured group program focused on self-help strategies. Methods: A hundred and twenty-six patients with OA were recruited from nine Primary Health Care Posts. The experimental group received a 6-week self-help education program while the control group received usual care. T-tests and c2-tests were used to determine the homogeneity between the experimental and control groups. Independent sample t-tests were performed to determine the effect of the treatment program. To guard against such likelihood, the level of significance of t-test was determined by Bonferroni correction within the study constructs. When significant group differences were found in study variables at baseline, analysis of covariances (ANCOVAs) were used for group comparisons of outcome variables. Results: The experimental group reported more significant improvement in fatigue, difficulty with physical activity, depression, quality of life, self-efficacy, and health behaviors than did the control group. The experimental group also showed improvements in range of motion and muscle strength as compared to the control group. Conclusion: A self-help group education program was an effective and powerful strategy to promote physical and psychosocial health in OA patients

A self-management program for veterans and spouses living with Parkinson’s disease

nelson n, wong d & lai e (2011) Journal of Nursing and Healthcare of Chronic Illness3, 496–503 A self-management program for veterans and spouses living with Parkinson’s disease Aims and objectives. The objective of this study was to determine whether Veterans and their spouses would participate in a self-management educational programme where they would practise the principles of self-efficacy for managing their chronic illnesses. The programme was designed using the Chronic Disease Self-Management Program of Stanford University in Palo Alto, California. Background. Whereas programmes for self-management of chronic conditions (arthritis, AIDS, diabetes) have been established for some time, only a few specific programmes for Parkinson’s disease had been cited in the literature at the time of this study. In this report, we describe our initial attempts at recruitment, administration and evaluation of this programme for a small group of participants with the specific intent of assessing its feasibility and appropriateness for Veterans seen in an outpatient setting. Conclusions. Our study revealed that participants were willing to commit to an intensive interventional programme, and within the group setting were able to apply the principles of self-efficacy with guidance from their peers and facilitator. The support of the group was a strong motivator for continued participation and the practice of self-management skills. However, the progression of Parkinson’s disease and the lack of long-term follow-up prevented the identification of measurable significant changes. Relevance to clinical practice. Patients living with chronic illness appear to benefit from group educational programmes, and this format could be adapted for others living with neurodegenerative illnesses and other chronic conditions.