Structured Education Program Research Articles

IDF21-0388 Fasting during Ramadan and resultant complications in people with type 1 diabetes

Aim: To examine the impact of the Dose Adjustment for Normal Eating (DAFNE) structured education program on reducing hypoglycemia episodes and diabetic ketoacidoses (DKA) in people with type 1 diabetes (T1D) who fasted Ramadan during the COVID-19 pandemic.

IDF21-0040 Effects of structured education program on Time in Range for people with type 1 diabetes

Background: The percentage of time in target glucose range (TIR) from continuous glucose monitoring (CGM) system is more specific and sensitive than HbA1c detection, and can better reflect the effects of acute hyper- and hypoglycemia. However, the successful utilization of CGM technology in routine clinical practice remains relatively low.

Effects of An Educational Programme on Knowledge of Cerebral Palsy among Informal Caregivers of Children Presenting at Selected Physiotherapy Clinics in Ibadan

Background: Children with Cerebral Palsy (CP) often require assistance from their informal caregivers to perform age-expected functions. These caregivers require sufficient knowledge of CP to effectively perform their roles. Effects of a structured education programme to improve CP knowledge among caregivers have been separately studied using single-module and multi-module educational programmes Information is however scarce on their differential effects. Objective: To compare the effects of single and multi-module educational programme interventions on the knowledge of CP among their informal caregivers. Methods: A quasi-experimental design involving 40 consecutively sampled informal caregivers of children with CP. They were assigned into either the single-module or the multi-module educational intervention groups. Baseline and post-intervention knowledge of CP were assessed using the Knowledge of Cerebral Palsy Questionnaire and compared using Wilcoxon signed- rank test and Mann-Whitney U test at p=0.05. Results: There was a significant within-group increase in the knowledge of CP in each of the two groups (p=0.001). Between-groups comparison revealed no statistically significant difference in the effects of either models (p= 0.26). Conclusion: The single-module and multiple module educational programme are equally effective in improving knowledge of CP and should be incorporated into the total management of CP.

Influence of formalized Predialysis Education Program (fPEP) on the chosen and definitive renal replacement therapy option.

It is widely accepted that patients with chronic kidney disease (CKD) should play an active role in the selection of renal replacement therapy (RRT) option. However, patients' knowledge about CKD and treatment options is limited. The implementation of structured education program and shared decision-making may result in a better preparation to RRT, more balanced choice of dialysis modalities and better access to kidney transplantation (TX). The aim of this long-term study was to assess the impact of formalized Predialysis Education Program (fPEP) on knowlege on RRT options, as well as on selected and definitive therapy. The study included 435 patients (53% men, mean age 60 years) with CKD stage 4 and 5, participating in fPEP at our center. The program included at least 3 visits, during which balanced information about all RRT options was presented and self-care and informed decision-making were encouraged. The knowledge about RRT options before and after fPEP attendance, and selected and definitive RRT options were assessed. Ninety-two percent of patients received prior nephrology care. After fPEP completion, in most patients, the knowledge about CKD and RRT options and selected preferred modality improved - 40% of participants chose hemodialysis (HD), 32% peritoneal dialysis (PD) and 18% TX. During the observation period, 4% of patients died before commencement of dialysis, 2.7% received preemptive kidney transplant, 8.6% were placed on transplant waiting list, and 94% started dialysis (30% PD and 70% HD). Among those who chose PD, 69% started PD and 24% started HD; the leading causes of the discrepancy between choosing and receiving PD was the deterioration in clinical condition (50%) and change of decision (32%). The fPEP increases CKD patients' knowledge on RRT methods. The implementation of a decision-making process based on fPEP leads to a satisfying distribution between modalities, with a good concordance between chosen and definitive modality.

The effectiveness of a structured group education programme for people with established type 2 diabetes in a multi-ethnic population in primary care: A cluster randomised trial

Background and aimsStructured self-management education has been shown to be effective in type 2 diabetes (T2DM) but more research is needed to look at culturally appropriate programmes in ethnic minority groups, where prevalence of T2DM is higher and diagnosis earlier. The study tested the effectiveness of a group education programme for people with established T2DM in a multi-ethnic primary care population. Methods and resultsCluster randomised trial conducted in two multi-ethnic UK sites. Practices were randomised (1:1) to a structured T2DM group education programme or to continue with routine care. A culturally-adapted version was offered to South Asians, who formed the majority of ethnic minority participants. Other ethnic minority groups were invited to attend the standard programme. Primary outcome was change in HbA1c at 12 months. All analyses accounted for clustering and baseline value.367 participants (64(SD 10.8) years, 36% women, 34% from minority ethnic groups) were recruited from 31 clusters. At 12 months, there was no difference in mean change in HbA1c between the two groups (−0.10%; (95% CI: −0.37, 0.17). Subgroup analyses suggested the intervention was effective at lowering HbA1c in White European compared with ethnic minority groups. The intervention group lost more body weight than the control group (−0.82 kg at 6 months and −1.06 kg at 12 months; both p = 0.03). ConclusionOverall, the programme did not result in HbA1c improvement but in subgroup analysis, a beneficial effect occurred in White Europeans. Findings emphasise a need to develop and evaluate culturally-relevant programmes for ethnic minority groups.

Outcome evaluation of an educational programme for preventing recidivism by adult firesetters

PurposeIn intervening to prevent recidivism by adult firesetters, there is a dearth of standardised interventions and relatedly of controlled outcome evaluations. Although education is a common firesetter intervention, it is unclear if this changes behaviour of adults; a research situation the current study aimed to address.Design/methodology/approachThe rate of actual fire recidivism of participants of a standardised educational programme was compared using Cooke’s (1989) equation to expected rates based on the firesetting history of 93 referrals.FindingsResults indicated a significant large effect for the difference between the frequencies of expected and actual firesetting re-offences.Research limitations/implicationsLimitations of the one-group pretest–posttest design are discussed with respect to potential confounds.Practical implicationsThis paper adds to the literature on adult firesetter interventions and lends support to the use of fire education to prevent fire recidivism. It provides the first empirically validated example of a structured education programme for adult firesetters. Of interest to services piloting new intervention programmes, it reports an operationally efficient methodology for preliminary evaluation.Originality/valueTo the best of the authors’ knowledge, this is the first reported outcome study of a fire safety education programme for adults. The methodology adopted represents a means of preliminary evaluation in safety-critical areas where traditional evaluation designs are infeasible.

Increased family history documentation in internal medicine resident continuity clinic at a community hospital through resident-led structured genetic education program.

We aim to assess residents' perspectives and clinical utility of obtaining family history (FH) as well as to improve the rate of FH documentation in electronic medical record (EMR) at an internal medicine resident continuity clinic at a community hospital. The residents' perspectives were assessed with questionnaires. The study period was divided into the first 10-week Phase 1 in which genetic education interventions were delivered by residents, and the second 10-week Phase 2 with minimal intervention. FH documentation in EMR was reviewed and compared to a 4-week baseline (Phase 0). We found that time constraint was the most reported barrier. We reviewed 1197 patient visits; FH was recorded in 34% (67/200), 52% (272/522), and 50% (239/475) during Phase 0, Phase1, and Phase 2, respectively. Genetic education significantly increased the rate of FH documentation in Phase 1 from baseline, which was maintained in Phase 2 despite removal of interventions. The mean age of patients with documented FH was younger than those without documentation (48years vs 51years; p < 0.001). Documented FH of cancers and coronary artery disease lacked important details, such as age at diagnosis, in 62% (86/138) and 51% (41/81) of them, respectively. Out of 511 patients that had documented FH, we identified 66 patients (13%) where positive family history could alter medical management. In conclusion, resident-led structured genetic education effectively increased family history documentation in EMR in internal medicine resident continuity clinic and showed clinical utility.

Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study

BackgroundBenefits from low back pain (LBP) treatments seem to be related to patients changing their pain cognitions and developing an increased sense of control. Still, little is known about how these changes occur. The objective of this study was to gain insights into possible shifts in the understanding of LBP and the sense of being able to manage pain among patients participating in a LBP self-management intervention.MethodsUsing a qualitative study and a content analytic framework, we investigated the experiences of patients with LBP who participated in ‘GLA:D® Back’, a group-based structured patient education and exercise program. Data were generated through qualitative semi-structured interviews conducted between January 2019 and October 2019. Interviews focused on experiences with pain and were analysed using a thematic analytical approach. The Common Sense Model and self-efficacy theory formed the theoretical framework for the interpretations. Participants were sampled to represent people who were either dissatisfied or satisfied with their participation in GLA:D® Back. Fifteen participants aged 26–62, eight women and seven men, were interviewed from February to April 2020.ResultsFour main themes, corresponding to the characterisation of four patient groups, were identified: ‘Feeling miscast, ‘Maintaining reservations', ‘Struggling with habits’ and ‘Handling it’. The participants within each group differed in how they understood, managed, and communicated about their LBP. Some retained the perception of LBP as a threatening disease, some expressed a changed understanding that did not translate into new behaviors, while others had changed their understanding of pain and their reaction to pain.ConclusionsThe same intervention was experienced very differently by different people dependent on how messages and communication resonated with the individual patient's experiences and prior understanding of LBP. Awareness of the ways that individuals’ understanding of LBP interact with behaviour and physical activities appear central for providing adaptive professional support and meeting the needs of individual patients.

COVID: The Missing Trigger to Start a Remote FIT Course.

Type 1 diabetes management is a highly demanding task that largely falls on people with diabetes, their family, and their peers. Diabetes self-management education and support aim at increasing knowledge, skills, and confidence to take appropriate diabetes management decisions. The current evidence shows that efficient diabetes self-management relies on person-centered interventions and a team of pluri-disciplinary educators with expertise in diabetes care and education. The irruption of the COVID-19 pandemic has increased diabetes burden and the need to offer remote diabetes self-management education services. The present article offers a perspective about expectations and quality issues related to the implementation of a remote version of the FIT course, a validated structured diabetes management educational program.

POS-799 Experimental study to evaluate the impact of structured education program in kidney transplantation among the nurses to improve the work efficiency and quality patient care

POS-799 Experimental study to evaluate the impact of structured education program in kidney transplantation among the nurses to improve the work efficiency and quality patient care

Implementing an evidence-based structured education and management program in an inpatient adult oncology setting to improve patients' pain control.

Cancer-related pain is prevalent across the cancer trajectory, and is probably one of the most feared of all cancer symptoms for patients and their families. Although there were guidelines and framework regarding the management of cancer pain, pain control among patients remain suboptimal. This best practice implementation project aimed to improve patients' perception on cancer pain management and pain control through implementing structured patient and family education and patient information leaflet (PIL) on managing cancer pain. The current implementation project conducted in an adult oncology inpatient unit utilized the JBI Practical Application of Clinical Evidence System and Getting Research into Practice module for promoting evidence-based health care. A comparison between the preimplementation and postimplementation findings showed significant improvements for both audit criteria outcomes. The percentage of patients receiving verbal education rose from 0 to 69%, whereas the percentage of patients receiving PIL increased 0-100%. Patient compliance to analgesic regime increased from 0 to 100%. There was a significant improvement in patients' pain levels ( P < 0.001), with majority rate having none-mild pain post intervention. A structured educational program on cancer-related pain improved patients' knowledge on cancer-related pain management and pain control. Despite the remarkable increase in the compliance rate, further interventions may still be required to achieve 100% compliance. Continuous audits will be held to guide follow-up interventions to ensure compliance and sustention of the project.

Review the Evidence for Structured Education in Diabetes Management

Structured Education is of detrimental importance for the management, counseling, and prevention of complications in diabetic patients. Different structured education programs exist that significantly improves the quality of life in diabetic patients as well as improves psychosocial outcomes by enhancing self-empowerment and self-motivation. Improvements have also been noted in bio-medical outcomes as a result of structured education most significantly in HbA1C, total cholesterol and frequency of hypoglycemia. In order to ensure patient satisfaction and improve outcomes related to complications, it is very important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care early in the course of the disease. In this review, we will discuss and highlight the evidence that support the benefits, limitations, and cost effectiveness of structured education in diabetes management

Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach.

BackgroundDigital health research encompasses methods from human-computer interaction and health research.ObjectiveThis paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes.MethodsThe development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions.ResultsThe initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program.ConclusionsThe use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs.

Parental Disease Specific Knowledge and Its Impact on Health-Related Quality of Life.

Objective: Structured education programs have been shown to improve somatic outcome and health-related quality of life (HRQOL) in a variety of chronic childhood diseases. Similar data are scarce in paediatric liver transplantation (pLTx). The purpose of this study was to examine the relationship of parental disease-specific knowledge and psychosocial disease outcome in patients after pLTx. Methods: Parents of 113 children (chronic liver disease n = 25, after pLTx n = 88) completed the transplant module of the HRQOL questionnaire PedsQL, the “Ulm quality of life inventory for parents of children with chronic diseases” ULQUI, and a tailor-made questionnaire to test disease-specific knowledge. Results: Parental knowledge was highest on the topic of “liver transplantation” and lowest in “basic background knowledge” (76% and 56% correct answers respectively). Knowledge performance was only marginally associated with HRQOL scores, with better knowledge being related to worse HRQOL outcomes. In contrast, self-estimation of knowledge performance showed significant positive correlations with both PedsQL and ULQUI results. Conclusion: Patient HRQOL and parental emotional wellbeing after pLTx are associated with positive self-estimation of parental disease-specific knowledge. Objective disease-specific knowledge has little impact on HRQOL. Parental education programs need to overcome language barriers and address self-efficacy in order to improve HRQOL after pLTx.

Estimating the cost of type 1 diabetes in Ireland.

Type 1 diabetes is a chronic disease, which given its existing and projected prevalence, is likely to pose a significant economic burden, both in terms of directs costs to the healthcare system and indirect costs to society. We aimed to estimate the economic burden of type 1 diabetes in Ireland, which at present, is unknown. A cost of illness study was undertaken to estimate the cost of type 1 diabetes in Ireland for 2018. Data for prevalence, morbidity, mortality, healthcare resource use, absenteeism, and unit costs were obtained from national, and where necessary, international sources. Direct healthcare costs were estimated for primary care, outpatient, emergency and inpatient care, for associated complications, structured education programmes, insulin and related care. Additionally, indirect costs from lost earnings due to premature death and employee absenteeism were estimated. Type 1 diabetes was estimated to cost €129million in Ireland in 2018, with direct healthcare costs accounting for €81.5million or 63% and indirect costs for €47.5million or 37% of the total. On average, this amounted to €3994 per patient in direct healthcare costs and €2326 per patient in indirect costs. Type 1 diabetes is a leading public health problem. Our study is the first to assess the economic burden of type 1 diabetes in Ireland, and our results should be informative to policymakers tasked with prioritising healthcare and research funding resource allocation.

Integrating Physicians Into Lean Quality Improvement Through a Structured Educational Program: The ECLIPSE Program.

In the increasingly complex health care system, physicians require skills and knowledge to participate with multidisciplinary team members in quality improvement (QI) that adds value to health care organizations. The Educational and Clinical Leaders Improving Performance with Structured E3L training (ECLIPSE) program was developed to address this challenge. Clinically relevant components of lean management were leveraged to create an online, flipped-classroom curriculum, and this was paired with Kaizen adapted specifically for physicians and multidisciplinary clinicians to promote experiential skills utilization. The focus of each adapted Kaizen was a topic of institutional QI priority, such as improving patient throughput or reducing readmission rates. Participants were awarded certification in the E3 Leadership management system-a patient-centered, equity-focused system based on lean principles. After 4 years, 50 E3 Leadership certificates were awarded to multidisciplinary clinicians, including 30 to physicians; participants scored an average 85% on module quizzes. The ECLIPSE program has improved physician participation in multidisciplinary QI projects with institutional alignment.

Factors influencing adherence to self-care practices among patients of type 2 diabetes mellitus from Saurashtra region of Gujarat: A conclusive research.

It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. A community based cross-sectional study was conducted among 178 type 2 DM patients. Self-care practices were evaluated for the last seven days and each item was scored from 0 (none of the days in a week) to 7 (all 7 days were followed). Adherence to medication (89.3%) and blood glucose monitoring (65.2%) were relatively higher than other domains. Factors associated with dietary adherence were secondary level education and above (OR = 22.1, 95% CI = 6.85 to 71.3), physician or endocrinologist treating doctors (OR = 3.36, 95% CI = 1.24 to 11.32), joint and three-generation family (OR = 3.32, 95% CI = 1.23 to 8.92) and upper and middle socioeconomic class (OR = 2.5, 95% CI = 1.1 to 6.2). Good glycemic control was significantly associated with dietary adherence (OR = 6.81, 95% CI = (2.71 to 17.16), medication adherence (OR = 4.59, 95% CI = 1.3 to 16.24) and regular exercise (OR = 3.65, 95% CI = 1.62 to 8.19). There is need to develop structured diabetes self-care education programs with involvement of private practitioners as a majority of the patients consult private practitioners for treatment. Health educators might have to place emphasis on self-care education to patients as well as caregivers belonging to low socioeconomic class and having lower education.

The Cost-Effectiveness Analysis of Self-Efficacy-Focused Structured Education Program for Patients With Type 2 Diabetes Mellitus in Mainland China Setting.

Objective: To assess the long-term (50 years) cost-effectiveness of the self-efficacy-focused structured education program (SSEP) as opposed to routine education among patients with type 2 diabetes mellitus (T2DM) in mainland China from a healthcare service perspective.Methods: A cost-effectiveness analysis method was used. The IQVIA CORE Diabetes Model (version 9.0) was adopted to estimate the outcomes. The baseline cohort characteristics, variations of physiological parameters, costs of intervention and other treatments, and management-related diabetes were derived from a randomized controlled trial. Moreover, the complications costs and utilities were extracted from published sources. Furthermore, the univariate sensitivity analysis and the probabilistic sensitivity analysis were conducted.Results: As compared with the control group, the life expectancy and quality-adjusted life-year in the intervention group were increased. Besides, the intervention group achieved lower cumulative incidences of complications and saved more direct medical costs compared with the control group. The sensitivity analysis revealed that the SSEP had 100% probability to be cost-effective.Conclusion: The SSEP is recognized as a highly cost-effective option for managing patients with T2DM, which are projected to both improve clinical outcomes and reduce costs.

Effect of Video-Assisted Teaching on Mothers' Knowledge and Practices Regarding Preserved Food and Their Children Health

Background: Improving the mothers' knowledge and practice regarding preserved food is very important and can reduce the effects of preserved food on their children's health. Aim: To evaluate the effect of video-assisted teaching on mothers' knowledge and practices regarding preserved food and their children health. Subjects and Methods: Design: A quasi-experimental research design was utilized in this study. Setting: This study was applied in Pediatric Outpatient Clinics at Sohag University Hospital. Sample: A convenient sample of (300) mothers was included in the study. Tools of data collection: One tool was used: (I) structured interviewing questionnaire, it consisted of three parts: (I) demographic data of the studied mothers, (II) knowledge assessment tool, and (III) reported practice assessment tool. Results: According to the findings of this study, after participating in a video-assisted structured education program mothers' total knowledge and practice about preserved foods improved with statistically significant differences. Conclusion: The current study concluded that video-assisted structured teaching was effective in improving mothers' knowledge and practices level regarding the effects of preserved food on their children's health. Recommendations: It is very important to provide mothers with a teaching program regarding the effects of preserved food on their children's health to promote and improve their knowledge and practices.

Improved blood glucose control, cardiovascular health and empowerment in people attending X‐PERT structured diabetes education

AbstractThe aim of the audit was to assess the change in key health markers in people with, or at risk of, diabetes who attended X‐PERT structured diabetes education.Data from X‐PERT programmes are entered into a central database. Twelve‐month changes in anthropometric and clinical variables – and diabetes medication usage – are reported for programmes run between 1 January 2017 and 31 December 2018. Where appropriate, paired t‐tests were performed.In total, 29,703 participants were registered to attend a programme during this period, of which 23,118 (78%) attended at least one session. Of those who attended at least one session 18,039 (78%) completed a programme. Ninety‐nine percent (3342) of participants with clinical data available had type 2 diabetes. Meaningful reductions in HbA1c were seen (‐8.6mmol/mol, 95% CI ‐9.2 to ‐8.0mmol/mol [‐0.8%, 95% CI ‐0.8 to ‐0.7%]; n=2957; p&lt;0.001); and there were statistically significant reductions in body weight, BMI, waist circumference, fasting blood glucose, total cholesterol, low‐density lipoprotein cholesterol, triglycerides, total cholesterol to high‐density lipoprotein cholesterol ratio, and triglycerides to high‐density lipoprotein cholesterol ratio (all p&lt;0.001). No change in high‐density lipoprotein cholesterol was observed. Of the 1180 participants who were recorded as taking diabetes medication at baseline, 632 (54%) were able to reduce the number of medications they were taking and 278 (24%) were able to omit them entirely. Participant empowerment score increased by 20%.Improvements in glycaemic control, weight management and cardiovascular disease risk, as well as reduced medication requirements and an increased feeling of empowerment, were observed in people who attended X‐PERT structured diabetes education programmes. Copyright © 2021 John Wiley &amp; Sons.