Group Self-management Education Research Articles

Attrition and social vulnerability during 2-year-long structured care in type 2 diabetes, the ERMIES randomized controlled trial

BackgroundDiabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition.MethodsThe ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, health-care access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition.ResultsThe global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression.ConclusionsSocial context, vulnerability, and health care history were related to attrition in this 2-year longitudinal comparative study of structured care. Considering these potential determinants and biases is of importance in scaling up interventions aimed at the optimization of long-term care in type 2 diabetes mellitus.Trial registrationID_RCB number: 2011-A00046-35, Clinicaltrials.gov number: NCT01425866 (Registration date: 30/08/2011).Source of funding: Ministry of Health, France.

Acceptability of Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults With Type 1 Diabetes: A Mixed Methods Approach

ObjectivesMixed methods were used to evaluate a group self-management education intervention to address type 1 diabetes (T1D)-specific barriers to physical activity (PA). We evaluated the acceptability of study resources and procedures. MethodsConsenting participants from a quantitative evaluation (n=70) were invited to participate in 1 of 5 focus groups. Interviews explored the acceptability of procedures across the randomized controlled trial schedule, acceptability of the intervention/control workshops and resources and the perceived effectiveness of the intervention/control on participant outcomes. The use and helpfulness of intervention take-home resources, Facebook data and fidelity coding were also examined to inform other aspects of intervention acceptability. ResultsTwenty-one focus group participants from control or intervention arms participated in 1 of the 5 focus groups. Participants were 46±10 years of age; about half were female and had been living with T1D for 23±16 years. Study procedures were widely accepted; however, randomization and some aspects of the questionnaire were of concern to a small number of participants. Group education was acceptable and preferred, but participants expressed ambivalence toward the private Facebook group. Control participants indicated that basic information on PA guidelines and hypoglycemia risk are not currently being provided in standard care. Fidelity assessment confirmed the intervention was delivered consistently and was facilitated using behaviours and communication skills based on social cognitive theory. ConclusionsFuture definitive evaluation of this promising intervention should utilize a blinded randomized controlled trial study design. Alterations to the control workshop are required to better reflect standard care in Australia. Our qualitative findings suggest that group education can be an acceptable and preferred method of education in T1D management for PA.

Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial

BackgroundYucatán, located in the southern region of Mexico, is the state with the country’s highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico. MethodsIn March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%). ResultsWhereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months. ConclusionsOur study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.

052 Occupational therapy-led fibromyalgia self-management education group programme: patients’ perspectives

Background: Fibromyalgia (FM) is characterised by the symptoms of chronic widespread pain, fatigue, unrefreshed sleep, cognitive difficulties and affects approximately one in 20 people in the UK. The EULAR revised guidelines for the management of FM recommended that non-pharmacological interventions should be prioritised. Occupational therapists at the Rheumatology Outpatients Department, Leighton Hospital, Mid Cheshire NHS Hospitals Foundation Trust developed the Fibromyalgia Self-Management Education (FAMe) Group Programme, with extensive research and patient partner involvement. The primary aim of this programme is to support self-management of FM using behaviour change interventions as outlined in the NICE recommendations. FAMe comprises 2.5 hrs weekly sessions over six weeks (6-Wks) and core components include education about FM, pain, fatigue, sleep and mood management, dealing with dyscognition, physical exercise and practicing mindfulness, based on Cognitive Behavioural Therapy (CBT) and Motivational Interview (MI) approaches. Methods: Patients with a primary diagnosis of FM, were screened and recruited from the rheumatology department of the Leighton Hospital by occupational therapists. Following the completion of the 6-Wks FAMe Group Programme, focus groups (FG) were held at the hospital to obtain patient perspectives on the programme content, delivery and impact on their self-management. In total, 14 patients aged between 19 to 67 attended three focus groups [FG1: n = 6 [F] FG2: n = 3 [F] FG3: n = 5 [2M:3F]]. Transcriptions were analysed by three independent researchers, not involved in the initial design or the delivery of this programme, using thematic analysis under the theoretical framework of critical realism. Results: Focus groups findings indicated that patients have greatly valued the support they have received from the group members and made significant behaviour changes both during and following the completion of the 6-Wks programme. These included: increasing physical activity levels, better stress, pain and mood management, and becoming more assertive. They have gained self-awareness and felt empowered to make the lifestyle changes they needed to better manage their symptoms. A strong theme about the need for health professionals to be more empathetic and knowledgeable about FM have emerged, as patients felt that many people with FM are not getting the support they need from clinicians. Importance of the need for educating the significant others and families was emphasised, as the lifestyle changes they needed to make involved changes to the roles, responsibilities and daily routines of others, which were deemed as a main barrier to making behavioural changes. Conclusion: Patients perceived the FAMe programme as highly acceptable and beneficial to self-management. The importance of educating families and health professionals on FM was stressed. Future interventions should aim to inform and educate clinicians and families of people with FM to create a supportive environment that would enable them to make behavioural and lifestyle changes they need to enhance self-management.

Baby Steps \u2013 a structured group education programme with accompanying mobile web application designed to promote physical activity in women with a history of gestational diabetes: study protocol for a randomised controlled trial

BackgroundA diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM.MethodsThe study is a randomised controlled trial with follow-up at 6 and 12 months. Primary outcome is change in objectively measured average daily physical activity at 12 months. Secondary outcomes include lipid profile, blood pressure, glycated haemoglobin, obesity, smoking and alcohol status, self-reported physical activity, anxiety, depression and quality of life. Participants are recruited from maternity and diabetes departments in hospital trusts in two sites in the UK. Women aged > 18 years, with a diagnosis of GDM during any pregnancy in the previous 60 months are eligible. Participants need to have a good understanding of written and verbal English, be able to give informed consent and have access to a smart-phone. Women who are pregnant or have type 1 or type 2 diabetes are not eligible. In total, 290 participants will be recruited and randomly assigned, with stratification for age and ethnicity, to either the control group, receiving usual care, or the intervention group who are invited to participate in the Baby Steps programme. This comprises a group education programme and access to a mobile web application which provides an education component and interacts with a wrist-worn activity monitor providing automated messages, setting challenges and encouraging motivation.DiscussionIf effective, the Baby Steps programme could be translated into a primary care-based intervention that women with GDM are referred to in the postnatal period. This could help them make lifestyle changes that could reduce their future risk of T2D.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.

Assessing the effectiveness of a goal-setting session as part of a structured group self-management education programme for people with type 2 diabetes

ObjectivesTo measure the number of people who have identified a behaviour change goal and completed an action-plan to meet their goal on completion of a diabetes self-management education programme (DSME) and level of success in sustaining their action-plan. The DSME people attended was Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND). MethodsCopies of action-plans were collected from participants. Postal questionnaires were sent to participants one week and three months following DESMOND to assess factors associated with setting and sustaining action-plans. Results92% (253/275) of participants completed an action-plan. Reducing weight was the area most targeted. Physical activity was the most common goal. 68% (187/275) returned a three month questionnaire. 96% indicated they were still working on their action plan, with 87% reporting they were always/usually meeting their action-plan. 22% said they had discussed their goal with a health care professional (HCP) following DESMOND. ConclusionsGoal-setting as part of a DSME can lead to behaviour change. Practice implicationsGoal-setting as part of a DSME enables participants to set and attain behaviour change goals. Informing HCPs of a person's action-plan following a DSME may further support a person undertaking behaviour change.

New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study.

BackgroundDiabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients.ObjectiveOur hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis.MethodsWe used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group.ResultsWe recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium (Δ=0.56). Usability ratings of NODE were excellent.ConclusionsNODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease.

The effectiveness of a group self-management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial.

SummaryObjectiveEpilepsy is one of the most common neurological conditions affecting about 1% of adults. Up to 40% of people with epilepsy (PWE) report recurring seizures while on medication. And optimal functioning requires good self‐management. Our objective was to evaluate a group self‐management education courses for people with epilepsy and drug‐resistant seizures by means of a multicenter, pragmatic, parallel group, randomized controlled trial.MethodsWe recruited adults with epilepsy, having ≥2 seizures in the prior 12 months, from specialist clinics. Consenting participants were randomized 1:1 to a group course or treatment as usual. The primary outcome measure was quality of life 12 months after randomization using Quality of Life 31‐P (QOLIE‐31‐P). Secondary outcome measures were seizure frequency and recency, psychological distress, impact and stigma of epilepsy, self‐mastery, medication adherence, and adverse effects. Analysis of outcomes followed the intention‐to‐treat principle using mixed‐effects regression models.ResultsWe enrolled 404 participants (intervention: n = 205, control: n = 199) with 331 (82%) completing 12‐month follow‐up (intervention: n = 163, control: n = 168). Mean age was 41.7 years, ranging from 16 to 85, 54% were female and 75% were white. From the intervention arm, 73.7% attended all or some of the course. At 12‐month follow‐up, there were no statistically significant differences between trial arms in QOLIE‐31‐P (intervention mean: 67.4, standard deviation [SD]: 13.5; control mean: 69.5, SD 14.8) or in secondary outcome measures.SignificanceThis is the first pragmatic trial of group education for people with poorly controlled epilepsy. Recruitment, course attendance, and follow‐up rates were higher than expected. The results show that the primary outcome and quality of life did not differ between the trial arms after 12 months. We found a high prevalence of felt‐stigma and psychological distress in this group of people with drug‐resistant seizures. To address this, social and psychological interventions require evaluation, and may be necessary before or alongside self‐management‐education courses.

Effect of self-management education versus quadriceps strengthening exercises on pain and function in patients with knee osteoarthritis

PurposeTo investigate and compare the effects of 6-week self-management education (SME) and quadriceps strengthening exercises (QSE) on pain and disability in individuals with knee osteoarthritis (OA).MethodsA total of 79 (13 males, 66 females) consecutive patients with knee OA were randomised into SME and QSE groups. The SME group were taught modules of self-management once a week for 6 weeks, while the QSE group had supervised QSE thrice a week for 6 weeks. Pain intensity and physical function were assessed with the Visual Analogue Scale and Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) at baseline, week 6, and at the follow-up time points of the 1&lt;sup&gt;st&lt;/sup&gt;, 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; months.ResultsThe effects of both interventions were comparable (&lt;i&gt;p&lt;/i&gt; &gt; 0.005) during intervention and follow-up. During intervention, in both groups, pain intensity significantly decreased (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, effect size = 0.603) and IKHOAM scores improved (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, effect size = 0.540). There were significant time by group interaction effects during follow-up as pain intensity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, effect size = 0.085) did not change in the QSE group but further decreased in the SME group, IKHOAM scores (&lt;i&gt;p&lt;/i&gt; = 0.005, effect size = 0.053) remained the same in the SME group while it decreased in the QSE group with respect to the end of intervention (6th week).ConclusionsSupervised QSE and SME are both effective in reducing pain and disability in knee OA but improvements in the outcomes are better sustained with SME.

Evaluation of goal-setting/action planning in a diabetes group self-management education programme for people with type 2 diabetes (DESMOND) in Ireland and England

Introduction: Diabetes self-management education (DSME) aims to empower people to engage in effective self-management behaviour and behaviour change. Goal-setting/action planning has been incorporated into many DSMEs to facilitate behaviour change. However, this component of DSMEs is understudied. Using DESMOND as a model of a DSME, this study measures the number of people who have identified a behavioural change goal and completed an action plan to meet their goal on completion of DESMOND and how successful they have been in sustaining an action plan. Methods: Copies of completed goal-setting/action-planning forms were collected from participants following completion of DESMOND. Postal questionnaires were sent to participants at one week and at three months following DESMOND to assess individual factors associated with identifying goals and setting and sustaining of action plans. Results: 55% (279/511) of DESMOND attendees agreed to participate in the study. Four withdrew, leaving 275 for analysis purposes. Of the 275 included in the analysis, 92% (n =253) completed a goal-setting/action plan within one week of completion of DESMOND. 87% (n = 220) selected one or more goals they wanted to target. The most common goals targeted were reducing weight (49%), lowering blood glucose (35%) and lowering cholesterol (26%). Over two thirds included physical activity in their action plan with 24% combining it with dietary changes. 27% of participants focused on diet alone. 68% (186/275) of participants returned a three month questionnaire of which 92% (n = 172) responded to the question on whether they were still working on an action plan. 96% (n = 165) indicated that they were still working on an action plan. 87% were successful in sustaining their action plan with 16% (n = 26) meeting their action plan always and 71% (n = 116) meeting it usually. Discussion: Our results suggest that goal-setting as part of a DSME can lead to behaviour change with the majority of participants sustaining an action plan three months following completion of DESMOND. Over two thirds of people included physical activity as part of their action plan. Conclusion: The majority of participants reported successfully setting and sustaining their behaviour change action plan three months following completion of DESMOND. Lessons learned: Goal-setting as part of a group education self-management programme is acceptable to participants with the majority completing and sustaining their action plans. Limitations: Participants may have been more likely to complete an action plan than if they were not taking part in the study. Successful behaviour change was based on self-report which may have resulted in some successful behaviour change being reported because of social desirability. The percentage of successful behaviour change may have been overestimated as it was only evaluated in those who returned a 3 month questionnaire. Those lost to follow-up may have been less likely to have sustained their action plan. Suggestions for future research: The key mechanisms that lead to the successful initiation and sustainment of behaviour change in the real world needs to be better understood in people with type 2 diabetes.

The Effects of Mind Subtraction Meditation on Breast Cancer Survivors’ Psychological and Spiritual Well-being and Sleep Quality

Most breast cancer survivors experience psychological and spiritual distress, including depression, anxiety, perceived stress, and loss of meaningfulness in life. This distress can negatively impact physical health, quality of life, and quality of sleep. The aim of this study was to compare and examine the effectiveness of mind subtraction meditation (MSM) and a self-management education (SME) group on breast cancer survivors. A randomized controlled trial was conducted with South Korean female breast cancer survivors (stages I-III). Self-reported questionnaires were administered to both MSM group (n = 22) and SME group (n = 24) to measure psychological and spiritual well-being, as well as quality of sleep. Compared with the SME group, the MSM group reported a significant decrease in depression (P = .034), anxiety (P = .036), and perceived stress (P = .009) and an increase in quality of life (P < .001), satisfaction with life (P < .001), posttraumatic growth (P = .007), and quality of sleep (P = .010). Mind subtraction meditation may have positive therapeutic effects among breast cancer survivors. This meditation program may be useful to manage psychological and spiritual distress, as well as improve quality of life and sleep, in clinical settings among breast cancer survivors. This study demonstrated the clinical effectiveness and the feasibility of applying the MSM method to breast cancer survivors. The participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.

Creating self-management teamlets in a primary care clinic; the successes of a clinical-peer team

Background to current teamlet model: The _Kia Kaha: Manage Better, Feel Stronger_ collaborative (supported by the Nirvana Health Group in partnership with the Beyond 20,000 Bed Days Campaign, Ko Awatea) http://koawatea.co.nz/the-kia-kaha-team-publish-a-health-system-improvement-guide utilised improvement science methods to create a change package that addresses mental health needs and supports self-management education for people with 2 or more long term conditions and 2 or more recent emergency care (EC) presentations. Within the first year patient's EC presentations were reduced by 42%. With the addition of self-management trained peers on the team, engagement rates with patients climbed from 50% to 93%.Next Steps: Based on these results resources were obtained to further expand peer support programs to develop and test a _Wheel of Support_ based on _Building peer support programs to manage chronic disease: seven models of success_ (California Healthcare Foundation, 2006). The current teamlet working in the Otara Locality which is an ethnically diverse high needs community within South Auckland, now consists of two part time health psychologists, 8 employed peer health coaches and 10 volunteer self-management leaders with six language abilities which include: Maori, Hindi, Tongan, Samoan, Mandarin and English. Group self-management education (The Chronic Disease Self-Management Program from Stanford University, http://patienteducation.stanford.edu) is now being offered in multiple languages by this team.Individual self-management support is commencing with health coaches trained in the Center for Education in Primary Care (CEPC) _Health Coaching Curriculum_ (Bodenheimer &amp; Ghorob, 2014) working with patients with diabetes. These coaches are working in a teamlet which includes the GP, nurse, behavioural health and other clinic staff. Coaches are supervised and supported by a health psychologist. Health coaching is also being offered in multiple languages.Preliminary results:"Feedback from GP:" General practitioner in the teamlet has expressed the positive impact of the health coaching on his consults with patients understanding more about concepts related to their diabetes such as the definition of diabetes, HbA1c and lifestyle goals."Psychological distress:" Observed significant reductions in anxiety, depression and somatisation."Patient Activation" Increased health behaviours and understanding of health information as measured on the Health Education Impact Questionnaire (hei-q)and as observed in further engagement with other self-management opportunities"Patient satisfaction and feedback" Qualitative thematic analysis related to social support, connection, self-esteem and confidence"Health outcomes" Modest to significant improvements on HbA1c, Blood pressure, weight and cholesterol"Healthcare utilisation" Decrease in unplanned primary care visits

Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis.

Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed. Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911. 42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I 2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I 2 = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I 2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I 2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I 2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I 2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I 2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer). The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.

Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study.

Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling. With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups. Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39). Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.

만성질환 노인을 위한 운동교실 통합 자기관리교육 프로그램(하하프로그램)의 개발과정과 내용

Purpose: This paper presents the development process and the final contents of the sellf- management education program integrated with exercise training (Healthy Aging Happy Aging, HAHA program) for community residing older adults with chronic diseases. Methods: The program evaluation methodology was applied which is an interactive program development process based on needs assessment, formative evaluation, process evaluation and outcome evaluation. The program was developed and revised while the program was implementing to 22 hypertension (HT) and 32 diabetic (DM) participants. Results: The final program has two sub-programs for HT and DM participants utilizing self-efficacy resources. They share four common components; 1) health screening of exercise risks, 2) weekly 1-hour group self-management education classes, 3) biweekly 1-hour group exercise training and 4) a mid-term individual counseling. Both sub-programs were 12-weeks long but have different education and exercise contents. Participants-rated mean satisfaction scores were 3.47/4 and 3.61/4 for HT and DM program respectively. Attendance rate were 83.1% ~ 92.3% for the classes. Conclusion: The HAHA program developed by multidisciplinary team which reflected participants needs was accepted well by participants evidenced by high attendance rate and perceived satisfaction level.

‘Getting your Life Back on Track after Stroke’: A Phase II Multi-Centered, Single-Blind, Randomized, Controlled Trial of the Stroke Self-Management Program Vs. the Stanford Chronic Condition Self-Management Program or Standard Care in Stroke Survivors

Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial. Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements, Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either; * standard care, * standard care plus a six week generic chronic condition self-management group education program, or, * standard care plus an eight week stroke specific self-management education group program. Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months. The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events. Secondary outcomes include: * positive and active engagement in life measured by the Health Education Impact Questionnaire, * improvements in quality of life measured by the Assessment of Quality of Life instrument, * improvements in mood measured by the Irritability, Depression and Anxiety Scale, * health resource utilization measured by a participant held diary and safety. The results of this study will determine whether a definitive Phase III efficacy trial is justified.

Supporting diabetes self-management in primary care: Pilot-study of a group-based programme focusing on diet and exercise

Aims To develop and implement a group self-management education programme for people with type 2 diabetes at the community level in primary care. This pilot-study intended to evaluate the feasibility, acceptability and long-term effects (12–18 months) of this programme on emotional distress, HbA1c, BMI and actual behaviour. Methods An empowerment-based, theory-driven education programme was evaluated in a before-after design. The programme focused on behaviour assessment, goal-setting, problem solving and tailored information. A diabetes specialist nurse conjointly with a dietician or psychologist led five 2-hour sessions and a follow-up meeting after 3 months. Results Forty-four people participated in 5 groups. BMI decreased with 0.45 kg/m 2 (95%CI 0.01–0.89) at 12-month and with 0.53 kg/m 2 (95%CI 0.02–1.04) at 18-month follow-up. HbA1c declined from 7.4% (±1.3) to 6.8% (±0.8) ( p = 0.040) and the PAID-score diminished from 28 (±20) to 18 (±13) ( p = 0.006) at 12-month post-intervention. These changes were only partly sustained at 18-month follow-up. Actual behaviour changed modestly. Conclusion Introducing the group education programme in primary healthcare is worthwhile (feasibility and effectiveness). A detailed description of the intervention is offered. Further research should explore the actual education process in greater depth.

Effect of a Low–Resource-Intensive Lifestyle Modification Program Incorporating Gymnasium-Based and Home-Based Resistance Training on Type 2 Diabetes Risk in Australian Adults

OBJECTIVE—The purpose of this study was to assess the effectiveness of a low–resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk.RESEARCH DESIGN AND METHODS—A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors; 36.9% had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) at baseline. The intervention included a 6-week group self-management education program, a gymnasium-based or home-based 12-week resistance training program, and a 34-week maintenance program. Fasting plasma glucose (FPG) and 2-h plasma glucose, blood lipids, blood pressure, body composition, physical activity, and diet were assessed at baseline and week 52.RESULTS—Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l (95% CI −0.60 to −0.08) and 0.15 mmol/l (−0.23 to −0.07), respectively. The proportion of participants with IFG or IGT decreased from 36.9 to 23.0% (P = 0.006). Mean weight loss was 4.07 kg (−4.99 to −3.15). The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group (P = 0.008).CONCLUSIONS—This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low–resource-intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT. The effects of home-based and gymnasium-based resistance training did not differ significantly.

Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective

This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were content analyzed with respect to motivation to participate and the effects of the program on them. The limited effects of the self-management program appear to be linked with low motivation to participate and to change health behavior. The data show that a decline in health and also stressful life events might be associated with the disappointing effects of the program. Three strategies were proposed for improving the program's effects: (a) provide information about the program in advance to ensure that patients have appropriate expectations. (b) Enhance intrinsic motivation to change health behavior by counseling techniques. (c) Tailoring with respect to motivation and current concerns could help to form more homogeneous groups or could be the basis for a tailored online intervention.