Diabetes EducationA Critical Review

By Prof. Morsi Arab

2004

Targets and Pathways in Diabetes Education

* physician * Nurse Patient * pharmacist * understandingEducation * Specialized * Self managePlanner - Diet * avoid compl. - exercise * improve quality - foot care, etc of life - Prof. Educator - volunteer - Pier education (in groups) - family member ( eg. Mother)

Diabetes Education

Diabetes Education = 50% of success in management (control) of Diabetes and prevention (1ry, 2dry and 3ry ) of its complications

Historical Development of Diabetes Education (Global)

- In Portugal (Dr. Roma): first education programme.- Joslin USA ,1922: Ed. Classroom- British Diab. Ass. ,1925 : Information – Skills-- attitude.- Role of Nurse in Ed, 1980-82,Diab. Care & Lancet.

*Indicators of the value of Education : - Hospital admissions (for DKA , foot, ulcers & hypoglycaemia). - Incidence of amputations - Effect on glycaemic control …..??? * WHO and IDF: - World Diabetes Days. - Regional Declarations ( St. Vincent – San Jose- Alexandria ).

- IDF Education Foundation.

Historical Dev. Of Diab. Ed. In Egypt

1962-1970 : Interactions with Brit. D.A. (UK) and Dept. of Med. Ed. (USA).1970-1980:- Alex. D. A. (First pt.ed.prog ) - Acquiring professional ed. technology : * WHO training (Shiraz) * USA North Carolina * USA Univ. of Illinois

1980-1990 Extensive patient and physician courses1990-2003 - first Nurse Ed. Prog. 1991 - collaboration with Min. of Health for Nurse Training Prog . - Pharmacist Education Prog. - Combined courses in Governorates

- Collaboration with IDF Ed.Foundation * video films in Arabic . * Nurse Guide Book. - The Alexandria Declaration on patient education

Objectives

Evaluation Strategy

Education

OBJECTIVES in Diabetes Education 1- Educate who? : Patient--Physician – Nurse .etc. – Public (awareness ).?2- Education Domains: a- Cognition (knowledge): levels? b- Skills c- attitudes3- From which background ?4- To achieve what ? to which level of

competence?

The Background of the Educator 1. Who educates : Physician , Nurse ,Dietitian other HC persons , professional Educator , Pier (precaution !!). 2. Knowledge of contents (diabetes).3. Professional Education skills (viz)4. Member in Education Team (no controversies).

* The biased educator.

The Background of The Learner

1. His General Knowledge and ed.(eg.illiteracy) 2. His Specific knowledge and ed. in diabetes: * not necessarily correlated with his gen. Kn. or ed. * relation to the Duration of Diab. ? - not necessarily nil at the onset - and not necessarily satisfactory with long durations. (usually

distorted ).

- The Background of The Learner (cont.)

3.His psychological “Stage of Acceptance” (viz)…4.His diabetes status : (controlled / uncontrolled-- complicated– handicapped ?)5.His basic attitudes,perception and belief about: cause of his illness--consequences –value of treatment-- cost/benefit – slavery to

specific habits (eg. smoking) .

1 -DenialI am not sickNot concerned, unlikely to benefit from education

2 -RevoltWhy me?Mis-interprets & distorts informat. given. Fails to remember

3-BargainOK , but I know what to do

Ready to learn. Demands to learn

Pt education : psychological acceptance and readiness to learn

4 -Depression I am sick , I shall take Rx,but shall I

be able to cope?

Also ready to learn

5 -Acceptance I shall live with it ……

Most receptive : attentive, ready to discuss ,accepts suggestions & corrections

Pt education : psychological acceptance and readiness to learn (cont.)

A-V Aids in Pt Education (Diet sheet--Handbooks --Pamphlets --Slides – Video tapes –Self evaluation check lists – Computer prog. with Q & A, etc)

1.selected to meet the objectives and match the learner’s abilities. 2. avoid : too complex leaflets – long video prog. (7-10min…. with only 2-3 concepts) contradictory information – Foreign language ( or badly translated). 3. should not be intended to escape from direct

talking to people .

Education Skills :

- In one-to-one Education: (listen , motivate,individualize to stage, not too much,reward more than blame,etc.)

- In Group Education: - Size of the group. - Group dynamics (+ve & -ve behaviours) - Educate not teach (active participation)

Education Skills (cont.) :

- Clever use of AV aids - Pamphlets - Booklets - Slides - Video tapes - Computer programmes

- Pitfalls in using Media for Mass Education.

Education to change attitudes:The uncompliant patient resents Education:

1- At the early stages of:denial protest & refusal .2- Slave of a habit : smoking , exercise , eating. 3- Adherence to background belief about the cause of his diab., his health locus of control (external forces or inside self ?).

The uncompliant patient (cont.) 4- Depression after: - unachievable goals (eg in body wt). - repeated failure of glycaemic control . 5- Transient stress by:social,economic or intercurrent illness.

N:B: Changing attitudes should be individualized.

Physician Education in Egypt Indicators of inadequacy :

* Indirectly, from studies on patients status: 1- High prev. of glycaemic uncontrol . 2- Uncontrol of other parameters e.g. hypertension,hyper-cholestrolemia.etc 3- High prevalence of hospital admissions for complications.DKA,Hypo,Foot inf, etc

Physician Education in Egypt (cont.)Indicators of inadequacy :

4- Reflection on poor patient information (e.g about syringes , etc). N.B.: There are no direct studies on the relation of implementation of education prog.to physician’s achievements of ed. skills.

Common Causes of failure in patient Education

1- Objectives unsuitable to cultural background , attitudes, beliefs , psychological status ,stage of illness, etc of the learner. Non achievable objectives.2- Educator without proper educational skills and/or sufficient knowledge of the programme content .3- Lack of, maldistribution or wrong selection of ed.resources (personnel , equip., aids, etc)

Causes of inadequacy of physician’s Education outcome: 1.Incoordination of Education programmes (place and time maldistribution ). 2.Lacking of professional educational skills. 3. Wrong selection of objectives. 4. Poor cost-benefit (Education Parties ): * minimal attendance * false certification * too short courses

Causes of inadequacy of physician education ( cont.)

5.Unsuitable content (confusing basic training with high tec. theoretical knowledge ). 6. lack of evaluation and follow up of

outcomes.

Causes of inadequacy of physician education ( cont.)

7.Biased Education ( conflicts of interest ). 8.Lack of national collaboration to produce: * unified guide-lines for ed. prog. * unified assessments of outcomes. 9.Lack of accountability to specific reference

authorities .