Group Education Program Research Articles

Validation of diabetes knowledge questionnaire in Croatian with assessment of diabetes knowledge and quality of life in patients with type 2 diabetes mellitus

Background. Diabetes mellitus (DM) is one of the biggest challenges in global healthcare and society in general. Assessment of the patient’s level of knowledge regarding diabetes is an important step in adapting group education programs to achieve better treatment outcomes. The aim of this study was to validate Diabetes Knowledge Questionnaire (DKQ) in Croatian language, to evaluate knowledge about diabetes and examine the relationship between knowledge and quality of life among type 2 DM patient’s in Croatia. Methods. The study was conducted as a cross-sectional study on 500 subjects. Validation of DKQ questionnaire in Croatian language was done using forward-backward method and internal consistency was examined using Cronbach’s Alpha. Quality of life was assessed using WHOQOL-BREF Questionnaire. Results. Good reliability and internal consistency of DKQ was confirmed (a = 0,740). Overall knowledge about diabetes was satisfactory (average DKQ score was 12,13). Longer duration of disease and previous education about diabetes were observed as predictive factors of better knowledge. No association was found between diabetes knowledge and quality of life. Conclusions. Our study confirms that DKQ is a good tool for assessing diabetes knowledge in Croatian language. Patients with DM demonstrated good diabetes knowledge but education in areas of self-care and nutrition needs to be improved which may increase quality of life.

Effectiveness of nutrition education and counseling on metabolic control parameters of diabetes mellitus type 2 patients in primary health care centers

Background. Diet compliance is an essential part of the treatment and control of diabetes. The present study aimed to determine the effectiveness of education and face to face diet counseling on metabolic control parameters of patients with type 2 diabetes in primary health care centers. Methods. This quasi-experimental study was conducted on 90 T2DM patients who referred to Andimeshk community health centers in 2018. Patients were randomly divided into two intervention (n = 45) and control (n = 45) groups. Data were analyzed by independent t-test, paired t-test and Chi-square using SPSS-18 software. Results. Sixteen weeks after the implementation of the nutrition education and counseling program, there was a significant decrease in the clinical, anthropometric, and biochemical parameters of the intervention group (P 0.05). Conclusion. The research findings show that the implementation of group education program, along with individual nutrition counseling, is very effective and can lead to weight loss, improved blood pressure and better control of blood glucose and lipids in T2DM patients. Therefore, the combination of education and counseling as two complementary methods in the treatment and control of diseases such as diabetes seems essential and effective.

Effectiveness of Internet-Based Multicomponent Interventions for Patients and Health Care Professionals to Improve Clinical Outcomes in Type 2 Diabetes Evaluated Through the INDICA Study: Multiarm Cluster Randomized Controlled Trial.

BackgroundType 2 diabetes mellitus (T2DM) is a chronic disease in which health outcomes are related to decision making by patients and health care professionals.ObjectiveThis study aims to assess the effectiveness of internet-based multicomponent interventions to support decision making of all actors involved in the care of patients with T2DM in primary care.MethodsThe INDICA study is an open, community-based, multicenter trial with random allocation to usual care or the intervention for patients, the intervention for health care professionals in primary care, or the combined intervention for both. In the intervention for patients, participants received an educational group program and were monitored and supported by logs, a web-based platform, and automated SMS. Those in the intervention for professionals also received an educational program, a decision support tool embedded in the electronic clinical record, and periodic feedback about patients’ results. A total of 2334 people with T2DM, regardless of glycated hemoglobin (HbA1c) levels and without diabetes-related complications, were included. The primary end point was change in HbA1c level. The main analysis was performed using multilevel mixed models.ResultsFor the overall sample, the intervention for patients attained a significant mean reduction in HbA1c levels of ‒0.27 (95% CI ‒0.45 to ‒0.10) at month 3 and ‒0.26 (95% CI ‒0.44 to ‒0.08) at month 6 compared with usual care, which remained marginally significant at month 12. A clinically relevant reduction in HbA1c level was observed in 35.6% (191/537) of patients in the intervention for patients and 26.0% (152/586) of those in usual care at month 12 (P=.006). In the combined intervention, HbA1c reduction was significant until month 18 (181/557, 32.6% vs 140/586, 23.9%; P=.009). Considering the subgroup of patients uncontrolled at baseline, all interventions produced significant reductions in HbA1c levels across the entire study period: ‒0.49 (95% CI ‒0.70 to ‒0.27) for the intervention for patients, ‒0.35 (95% CI ‒0.59 to ‒0.14) for the intervention for professionals, and ‒0.35 (95% CI ‒0.57 to ‒0.13) for the combined intervention. Differences in HbA1c for the area under the curve considering the entire period were significant for the intervention for patients and the combined intervention compared with usual care (P=.03 for both). Compared with usual care, the intervention for professionals and the combined intervention had significant longer-term reductions in systolic and diastolic blood pressure.ConclusionsIn uncontrolled patients, the intervention for patients at baseline provided clinically relevant and significant longer-term reductions of HbA1c levels. The intervention for professionals and combined intervention also improved the cardiovascular risk profile of patients.Trial RegistrationClinicalTrials.gov NCT01657227; https://clinicaltrials.gov/ct2/show/NCT01657227

Group education program for hypertension control.

Hypertension continues to be a health crisis, with multiple approaches attempting to define best practices for management. The objective of our hypertension group education program is to improve patient health outcomes through engaging a multidisciplinary health professional team. A 6-hour group curriculum was created with a focus on nutrition, lifestyle, and medication approaches to hypertension management, while incorporating personally identified behavior change goals and barriers. Outcomes were tracked pre-program, at program completion, and 6 and 12months post-program completion. Program participants demonstrated immediate and sustained improvements in blood pressure readings and attainment of personal behavior change goals. Group hypertension education classes are an effective way to care for patients. Additional healthcare resources should be dedicated to creating and evaluating educational delivery models that are sustainable and provide results over time, including financial implications to the health system.

The Effects of a Stress Management Group Education Program on Symptoms of Depression, Anxiety, and Stress in People With Comorbid Diabetes and Chronic and/or Recurrent Foot and Ankle Complications

Individuals with diabetic foot and ankle complications are at heightened risk for depression, anxiety, and stress. This study evaluated the effect of a stress management group education (SMGE) program in this population. The 21-question Depression Anxiety Stress Scales and the Problem Areas in Diabetes scale were administered prior to, upon completion of, and at approximately 6 weeks after the program. Twenty-five patients from an urban diabetic foot and ankle center completed the study. The SMGE program demonstrated decreased levels of anxiety, depression, and diabetes problem areas for our study population.

Evaluation of an interdisciplinary group education curriculum for hypertension

Hypertension disproportionately affects African American communities. This interdisciplinary, group education curriculum aimed to improve hypertension knowledge, behavioral risk factors , weight, and blood pressure (BP) in an urban African American population with uncontrolled hypertension. Outcomes were assessed with paired t-tests in a pre-post study design. Participants (n = 20) demonstrated a significant increase in hypertension knowledge. Among self-reported health behaviors, maintaining a healthy weight improved significantly. Participants demonstrated significant weight loss at one month compared to baseline, and trended towards significance at three and six months. Participants’ baseline BP was 165/88 mmHg. Decreases in systolic BP trended towards significance at one month (△ = 12.27 mmHg) and decreased significantly at three months (△ = 23.06 mmHg) and six months (△ = 21.44 mmHg). Diastolic BP significantly decreased at one month (△ = 8.37 mmHg) and six months (△ = 8.61 mmHg) and trended towards significance at three months (△ = 7.41 mmHg). This interdisciplinary, group education intervention shows promise for improving hypertension management in African American populations. • This pre-post study assessed if an interdisciplinary, group education program improved hypertension among African Americans. • Post-intervention, participants had improved hypertension knowledge and weight loss. • Participants had a significant decrease of 21 mmHg in systolic BP and 9 mmHg in diastolic BP at six months follow-up.

Within-trial cost-effectiveness of lifestyle intervention using a 3-tier shared care approach for pregnancy outcomes in Chinese women with gestational diabetes.

This study assessed within-trial cost-effectiveness of a shared care program (SC, n = 339) for pregnancy outcomes compared to usual care (UC, n = 361), as implemented in a randomized trial of Chinese women with gestational diabetes (GDM). SC consisted of an individualized dietary advice and physical activity counseling program. The UC was a one-time group education program. The effectiveness was measured by number needed to treat (NNT) to prevent one macrosomia/large for gestational age (LGA) infant. The cost-effectiveness was measured by incremental cost-effectiveness ratio in terms of cost (2012 Chinese Yuan/US dollar) per case of macrosomia and LGA prevented. The study took both a health care system and a societal perspective. This study found that the NNT was 16/14 for macrosomia/LGA. The incremental cost for treating a pregnant woman was ¥1,877 ($298) from a health care system perspective and ¥2,056 ($327) from a societal perspective. The cost of preventing a case of macrosomia/LGA from the two corresponding perspectives were ¥30,032/¥26,278 ($4,775/$4,178) and ¥32,896/¥28,784 ($5,230/$4,577), respectively. Considering the potential severe adverse health and economic consequences of a macrosomia/LGA infant, our findings suggest that implementing this lifestyle intervention for women with GDM is an efficient use of health care resources.

Therapeutic Patient Education for Adrenal Insufficiency under COVID-19 Pandemic Conditions.

Adrenal insufficiency (AI) requires life-long treatment with glucocorticoid replacement therapy. Over- or under-substitution carries the risk of increased morbidity in the form of side effects or adrenal crises. Glucocorticoid replacement therapy needs to be flexible with dose adaptation in special situations. This could not be managed by medical personnel on a daily basis, but requires an educated patient who has a good knowledge of the disease, understands his medical therapy and is able to perform situational dose adaptation. The rarity of the disease in combination with the need to respond to stressful situations with rapid glucocorticoid dose adjustment underlines that a well-trained patient is crucial for optimal management of the disease.In this literature review we provide background information further clarifying the need of education in patients with AI including the current shortcomings of medical therapy and of the treatment of patients with AI. We outline the aims of therapeutic patient education, present the concept of structured patient education in Germany, and discuss available results of patient group education programs. Furthermore, we propose strategies how therapeutic patient education for adrenal insufficiency can be organized under COVID-19 pandemic conditions.

Impact of a structured educational programme for caregivers of children with cancer on parental knowledge of the disease and paediatric clinical outcomes during the first year of treatment.

To assess the impact of a structured educational programme for caregivers of children with cancer on their level of knowledge about the disease and patient's clinical outcome. This prospective, non-randomised, experimental study included caregivers of recently diagnosed children at two hospitals in Chile. Caregivers whose children were treated at the first centre were the structured education programme group (EPG), while the second hospital provided the standard care (SCG). We evaluated caregivers' level of knowledge on days 1, 10 and 90 as well as the children's clinical outcomes over 1year of treatment. A total of 102 caregivers were enrolled between 2014 and 2015. Only the EPG showed a significant increase in knowledge between days 1 and 90. The rate of central venous catheter infections was significantly lower in the EPG versus SCG (7% versus 26%; p=.01). The risk ratio was 0.35 (95% CI=0.13-0.94), and a log-rank test showed a statistically significant difference between the two groups (p=.018). There were also fewer Emergency Department visits in the EPG for fever episodes. Providing a structured education to caregivers increased their level of knowledge and improved the clinical outcome of their children during the first year of treatment.

THU0581 USE OF EHEALTH BY PATIENTS WITH RHEUMATOID ARTHRITIS: AN OBSERVATIONAL, CROSS SECTIONAL, MULTICENTER STUDY

Background:The use of eHealth tools (internet, mobile applications, connected devices) in chronic diseases and in the field of rheumatoid arthritis (RA) is growing (1). eHealth may improve the overall care of patients suffering from chronic diseases (2,3).Objectives:The main objective of this study was to describe the use of eHealth by RA patients in France. The secondary objectives were to identify differences in demographic and disease characteristics between patients using eHealth tools or not. We also assessed patients’ expectations about digital devices.Methods:We conducted a cross-sectional, multicenter study. Patients with RA according to the ACR / EULAR 2010 criteria were recruited in 5 university hospitals (Bordeaux, Clermont-Ferrand, Limoges, Montpellier and Toulouse). Patients completed an anonymous self-questionnaire including demographic data, assessment about the use of eHealth (access, support, frequency of use, type of use, reason for use). The treating rheumatologist of the patient filled in an independent medical questionnaire collecting the disease characteristics, the activity of RA and the treatments. Data were collected from December 2018 to July 2019.Results:The questionnaires were completed by 575 patients, with an average age of 62±13 years, 78% of whom were women. 473 (82%) patients had access to eHealth through a computer (n=402, 86%), a tablet (n=188, 40%) and/or a smartphone (n=221, 47%). Among them, 36% (170/473) used internet for health in general and 29% (134/473) specifically for RA. Regarding the use of eHealth for RA, all patients used it to learn about their disease and 66% (89/134) as a tool to help monitoring RA. Most of them (n=87/125, 70%) had a paper medical record, 24/125 patients (19%) used a digital tool (spreadsheet n=10, 8% and / or mobile application n=9, 7% and / or website n=5, 4%) and 31/125 patients (25%) did not use any tool to monitor their RA. Few patients (16/126, 13%) used numeric reminders for their treatments. A specific application for RA was used by 27/127 patients (21%) using eHealth. Age, level of study, employment, treatment, comorbidities, membership of a patient association group and patient education program were associated with the use of eHealth for RA in univariate analysis. In multivariate analysis, membership of patient’s association (OR: 5.8 [3.0-11.2]), bDMARDs use (OR: 0.6 [0.4-1]) and comorbidities (OR: 0.7 [0.6-0.8]) remained associated with eHealth use for RA. According to the patients, recommendation by a doctor (n=225/330, 68%), ease of use (n=105/330, 32%) and data security (n=69/330, 21%) were the factors that would favor the use of eHealth.Conclusion:To date, few patients used eHealth for their disease. The use of a reliable and validated eHealth tool in RA could therefore be promoted by rheumatologist and might optimize the therapeutic adherence.

Not Scared of Sugar™: Outcomes of a structured type 2 diabetes group education program for Chinese Australians.

Type 2 diabetes disproportionately affects the Chinese population yet there are no structured diabetes education programs specifically designed for this community in Australia. This project aimed to develop and evaluate a pilot type 2 diabetes group education program designed specifically for Chinese migrants living in Australia. A non-randomised pre- versus post-intervention trial was conducted between March 2017 and November 2018. A culturally tailored group education program (Not Scared of Sugar™) was developed and piloted with Melbourne-based Cantonese-speaking people with type 2 diabetes. Program teaching styles were aligned with the Confucian cultural process of learning and incorporated culturally specific strategies to promote healthy behaviour change. Thirty-four individuals (35% male) attended five education sessions over ten weeks, delivered by a Cantonese-speaking facilitator and multidisciplinary clinicians. Data were collected from participants at baseline, on program completion and at 6months follow-up. Mean (SD) participant age was 69 (9) years, with a mean time of 25.7 (10.8) years in Australia and a median duration of diabetes of 10 (IQR=2.8-20.5) years. At program completion, mean participant waist circumference (90.5 versus 89.2cm, p<.001) and waist-to-height ratio (0.574 vs. 0.566, p<.001) was significantly reduced and both were further reduced at 6-month follow-up (p<.05). There was a significant increase in the median frequency of diabetes self-care behaviours undertaken, with American Association of Diabetes Educators Questionnaire Score: 30 (22-32.3) versus 33 (29.8-35.0), p<.001 at 6-month follow-up. Diabetes-related distress assessed by PAID-C was also significantly reduced at 6-month follow-up (p<.05). Mean HbA1c was unchanged after 6months; 51 (7.9) versus 50 (7.8) mmol/mol, p=.316. Program attrition was 6%. Not Scared of Sugar™ successfully reduced waist circumference, increased diabetes self-management behaviours and reduced diabetes distress in Cantonese-speaking Australians, which may positively impact long-term risk of vascular complications.

Effect of coding and robotic education on pre-school children’s skills of scientific process

This study was carried out with the aim of determining the effect of robotic coding education on pre-school children’s skills of scientific process. Study group consisted of 30 children aged five who studied in an independent kindergarten connected to Ministry of National Education in Refahiye district of Erzincan province in the first semester of 2017–2018 academic year and 15 of them were in the experiment group and other 15 of them were included in the control group. In the study, experimental design with pre-test, post-test and control groups was used. “Scale for Preschool Students’ Basic Skills” developed by Aydogdu and Karakus (Kuramsal Egitimbilim Dergisi, 10 (1), 49-72, 2017) was applied to both experiment and control group before and after the education. After applying the pre-test to the students in the experiment group, “Coding and Robotic Education Program”, which consisted of 16 sessions, was also applied to them during eight weeks, two days a week and an hour a day. No programs were applied to the control group and they continued their education in their own programs. No programs were applied to the control group and they continued their education in their own programs. As a result of the study it was found that the post-test scores of the children in the experiment group were significantly higher than their pre-test scores. It was determined that there was no significant difference between the posttest scores and the pre-test scores of the control group. To sum up, it can be claimed that the robotic coding education, which was applied to preschool children, developed the children’s skills of scientific process.

Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial.

Online care platforms can support patients with type 2 diabetes (T2DM) in managing their health. However, in the use of eHealth, a low participation rate is common. The Proactive Interdisciplinary Self-Management (PRISMA) program, aimed at improving patients' self-management skills, was expected to encourage patients to manage their disease through the use of an online platform. Therefore, the objective of the current study was to investigate whether a group education program can improve the use of an online care platform in patients with T2DM treated by primary care providers in the Netherlands. In a randomized controlled trial, patients with T2DM received either PRISMA with usual care or usual care only. During a six-month follow-up period in 2014-2015, usage (number of log-ons and time spent per session) of an online care platform (e-Vita) aimed at improving T2DM self-management was assessed. A training about the functionalities of e-Vita was offered. The sample consisted of 203 patients. No differences were found between the intervention and control groups in the number of patients who attended the platform training (interested patients) (X2(1) = 0.58; p = 0.45), and the number of patients who logged on at least once (platform users) (X2(1) = 0.46; p = 0.50). In addition, no differences were found between the groups in the type of users—patients who logged on twice or more (active users) or patients who logged on once (nonactive users) (X2(1) = 0.56; p = 0.45). The PRISMA program did not change platform usage in patients with T2DM. In addition, only a small proportion of the patients logged on twice or more. Patients probably need other encouragements to manage their condition using an online platform.

Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

AbstractBackground:Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.Objective:The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.Methods:This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N = 100 GEP, N = 84 WEP and N = 69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9 ± 7.1 years; body mass index (BMI) 31.6 ± 5.8kg/m2), 40 GEP (age 42.9 ± 12.2 years; BMI 34.8 ± 9.0kg/m2) and 43 WEP (age 43.7 ± 8.1 years; BMI 30 ± 5.1kg/m2)] participants completed the study.Results:Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p = 0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p = 0.003), waist circumference (p = 0.017), systolic and diastolic blood pressure (p-values &lt; 0.01), triglycerides (p &lt; 0.001) and caloric intake (p &lt; 0.005) over time.Conclusion:Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

Comparing the effects of nursing versus peer-based education methods on the preoperative anxiety in infertile women: An RCT.

BackgroundPreoperative anxiety is a common event in patients expecting surgery. Education can play an important role in reducing the negative effects of anxiety on the response to treatment. Therefore, identifying the appropriate method is important.ObjectiveThe aim of this study was comparing the effects of nursing versus peer-based education on the preoperative anxiety in infertile women.Materials and MethodsIn this clinical trial, 198 eligible infertile women were randomized into three groups (n = 66/each): the nurse-educated, peer-educated, and the controls. The Spielberger State-Trait Anxiety Inventory was filled out by all participants for measuring the patient anxiety at the time of hospital admission and prior to surgery. Participants in the nurse-educated and peer-educated groups received a group education program by a nurse or peer, respectively, after the initial completion of the Spielberger State-Trait Anxiety Inventory.ResultsThe mean score anxiety was 44.47, 46.92, and 42.60 at the time of hospital admission and 39.38, 41.06, and 43.42 prior to surgery in nurse-educated, peer-educated, and the control groups, respectively. There was a significant difference in the mean score of anxiety in each group before and after the intervention (p 0.0001). However, the difference between the groups was not significant.ConclusionOur findings demonstrate that nursing and peer education programs both reduce the preoperative anxiety. Hence, optimal use of the peer's potential regarding the compensation for staff shortage for preoperative education as well as investigating the effect of individual education is suggested for further studies.

Schulungsprogramme verbessern Fatigue bei Multipler Sklerose

Hugos CL, Chen Z, Chen Y et al. A multicenter randomized controlled trial of two group education programs for fatigue in multiple sclerosis: Short- and medium-term benefits. Mult Scler 2019; 2: 275–285

Experiences of Attending Group Education to Support Insulin Initiation in Type 2 Diabetes: A Qualitative Study.

IntroductionType 2 diabetes is a progressive condition and many people require insulin therapy 5–10 years post diagnosis. Considering the global increase in type 2 diabetes, group education programmes to initiate insulin are beneficial as they are cost-effective and provide peer support. However, group education to initiate insulin has not been widely evaluated and there is a need to elicit the views and experience of people with type 2 diabetes who start insulin in groups. The aim of this study was to explore the perspectives of people with type 2 diabetes who receive nurse-led group-based insulin education.MethodsQualitative, semi-structured interviews of people with type 2 diabetes in south London, UK, who had attended group education sessions to start insulin. Inductive thematic analysis identified themes within the data.ResultsFifteen people with type 2 diabetes were interviewed. Three main themes were identified: creating a supportive environment; facilitator skills; and effectiveness of group. Factors which created a supportive environment included peer support, providing reassurance and printed materials. Facilitator skills associated with positive experiences included addressing negative insulin beliefs and managing group dynamics. The effectiveness of the group was determined by ongoing self-management success, need for more peer support, and insulin concerns post insulin education group.ConclusionPositive experiences of insulin group education for people with type 2 diabetes were associated with sharing experiences with other people starting insulin, reassurance from healthcare professionals, appropriate supportive materials, and skill of the facilitator to address insulin concerns and manage group dynamics. People with type 2 diabetes may benefit more from education if healthcare professionals are skilled in psychological techniques to facilitate group education aimed at addressing concerns around insulin therapy. Further research needs to assess the effectiveness of structured insulin group education for people with type 2 diabetes.

Utilizing a Peer Patient Advocate to Develop Sickle Cell Transition Educational Materials

Background: Peer patient advocates, also called peer advocates or peer supporters have the same chronic illness as the patients that they aid to manage their health care (MacLellan, 2017). Our team developed an interactive group educational program that aimed to prepare and guide adolescents and emerging adults (AEAs) with Sickle Cell Disease (SCD) as they transition from pediatric to adult care and included a peer patient advocate as a co-facilitator of the program. Here we describe a peer advocate led process to develop an educational booklet equipped with visual aids, tables, and pertinent definitions. To our knowledge, this is a novel use of a peer patient advocate as it has not been seen in the literature before. Methods: The first iteration of the booklet was developed by the peer patient advocate based on topics discovered as important to AEAs and parents through qualitative interviews. The intent of the booklet was to be a guide and resource to four AEA's ages 16-21 as they completed the group healthcare meetings The peer advocate drew on personal experiences with SCD to make the educational booklet as relevant as possible while integrating health information from the National Institutes of Health (National Institutes of Health, 2015), American Society of Hematology (American Society of Hematology, n.d.), and Got Transition (Got Transition, n.d.). The second iteration of the program and booklet facilitated by the peer patient advocate integrated lessons learned from the pilot and was used by twelve patients ranging in age from 14-21. Each AEA was called 1-7 days prior to the next group meeting to evaluate the educational material and share their experiences. These structured interviews took between 5-10 minutes to complete was audio-recorded and transcribed into a text file that could be used for feedback analysis. Results: The AEAs overall described the booklet as useful, easy to understand, and beneficial to their learning. It was described as a resources that they found useful to go to for quick information and they enjoyed that it was related to the information presented within the group. The project overall demonstrated that using peer patient advocates as guides to the healthcare team can be very instrumental in developing patient educational materials and programs. Although peer patient advocates are not experts in developing educational material, this project demonstrates that peer patient advocates can develop excellent patient educational materials that are usable and relatable to adolescent patients with sickle cell disease. Conclusions: Having a peer patient advocate as part of the team that creates the education material can increase pertinent, usable, and relatable information for AEAs with sickle cell disease. The team felt the peer advocate's contributions were vital to the booklet content. Including a peer patient advocate to develop patient education development for other chronic diseases may be valuable for AEAs with other chronic health conditions. Disclosures No relevant conflicts of interest to declare.

Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial

BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE).MethodsThe study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned.DiscussionImpact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting.Trial registrationClinicalTrial.gov NCT03537638. Registered on 25 May 2018.

Evaluating literacy levels of patient education materials for a sickle cell transition group education programme

Objective: A multidisciplinary team from a US midwestern urban medical centre developed written patient education materials for a group education programme designed to prepare adolescents and emerging adults with sickle cell disease for transition to adult care. We evaluated the literacy levels of these materials and demonstrate how to revise the patient education materials to meet literacy standards. Method: Six tools were used to evaluate literacy levels of the patient education materials. Based on the literacy level scores of the materials, including readability, grade level, understandability and actionability, recommendations and revisions were made to improve literacy levels. The revised materials were again assessed using the same six tools. Results: Initial literacy levels of the patient education materials were higher than recommended standards. Adjustments were made to meet literacy standards. Not all standards were met. Conclusion: Patient education materials should conform as much as possible to recommended literacy standards for optimum understandability. However, not all patient education materials can fully meet all evidence-based literacy standards. Recommendations for evaluating literacy standards when creating or providing previously developed patient education materials are discussed. Extra efforts to achieve acceptable literacy standards are recommended when medically complex educational materials are necessary.