Transcript The Knowledge Acquired from the Diabetes Education Clinic

The Knowledge Acquired from the
Diabetes Education Clinic Class at
the Pembroke Regional Hospital
Dietetic Intern: Qiuhong Han (Catherine)
Advisor: Mary Ann Carroll, RD CDE
Acknowledgements
Many thanks to all mentors and advisors
►
Pembroke Regional Hospital:
Mary Ann Carroll, RD CDE, Judy Hill, RD CDE, Manager of Clinical
Nutrition and Diabetes Education, Becky Campbell, Dietitian’s
Assistant
►
The Ottawa Hospital Dietetic Internship Program:
Barbara Khouzam, RD, MPA, Josee Bertrand, RD, Coordinator of
the Dietetic Internship, Renée Crompton, RD, Louise Gariepy,
Statistician, Lynne Lewis, Clerk of the internship,
Overview
► Introduction
► Procedures
► Results
and Methods
and Discussion
► Conclusion
Diabetes
► Chronic
degenerative illness with great
negative effects on health
► Prevalence
► Cost
in Canada > 2 million people1
of diabetes and its complications
~ $13.2 million / year2
Diabetes Education
►
Most complications are preventable by correct
self-management3
►
Significant knowledge deficit among those with
diabetes3
►
Diabetes education was introduced in the 1930’s.
►
Diabetes education enhances positive lifestyle
changes
►
Diabetes education programs are clinically
worthwhile and cost-effective4
DEC at the PRH
►
PRH one of five sites of Renfrew County Diabetes
Education Program
►
DEC is multidisciplinary: RDs, RNs, Dietitian’s Assistant
►
~1 hour group class
► Individual appointment with RD and RN
DEC= Diabetes Education Clinic
RD= Registered Dietitian
PRH=Pembroke Regional Hospital
RN= Registered Nurse
Study Objective and Goal
►
Determine the knowledge acquired by clients who
attend the DEC group class
►
Appropriately revise the presentation or material
presented in the DEC group class
Inclusion Criteria
►
> 18 years old
►
Pre-diabetes, type 1 or type 2 diabetes
►
Signed consent
►
Attended DEC group class between February 28th,
2008 and March 13th, 2008
►
Completed pre-class, post-class and one-weekfollow-up tests
►
20 qualified participants
The Questionnaire
►
Identical for all three tests
►
Based on DEC group class
►
Validated by 5 RDs and 2 RNs
(Diabetes Educators)
►
Two parts:
demographic section and knowledge section
Procedure
►
Pre-class test immediately before attending class
►
Post-class test immediately after class
►
One-week-follow-up test:
investigator by telephone
Data Analysis
►
SPSS 16.0 Graduate Student Version
►
Whether clients’ diabetes-related knowledge
improved after attending class
►
Whether knowledge improvement associated with
demographic characteristics
►
Pre-existing knowledge gaps
Results –
knowledge improvement
paired samples t-test plus Bonferroni Correction (p<0.017)
pair 1
pair 2
pair 3
mean
N
Std. Deviation
Sig.
overall score of pre-class test
6.7
20
2.812
0.000
overall score of post-class test
9.9
20
2.15
overall score of pre-class test
6.7
20
2.812
overall score of one-week-follow-up test
9.35
20
1.725
overall score of post-class test
9.9
20
2.15
overall score of one-week-follow-up test
9.35
20
1.725
0.000
0.248
Discussion
►
►
►
Diabetes-related knowledge improved
Retained knowledge for one week
Consistent with results from other similar studies5-9
Results – Demographics
►
Independent sample t-test plus Bonferroni Correction
(p<0.017)
►
Pre-class test: p<0.017
Males: 7.79 + 2.359
Females: 4.17 + 2.137
►
One-week-follow-up test: p<0.017
Males: 10.00 + 1.414
Females: 7.83 + 1.472
No statistically significant difference between
males and females on post-class test
Results
- Demographics
•
No significant differences associated with
►age
►type of diabetes
►duration of diabetes
►previously attended a diabetes class
►having seen an RD / RN for diabetes
►level of schooling
•
Previous studies: knowledge improvement not
related to demographic characteristics10
Discussion - demographics
Characteristic
N
%
Age
35-65
10
50
>65
10
50
14
70
6
30
pre-diabetes
2
10
type 1
0
0
type 2
13
65
5
25
<1 year
8
40
1-5 years
7
35
6-10 years
3
15
>10 years
2
10
Gender
male
female
Type of diabetes
I don't know
Duration of diabetes
Continue…
Characteristic
N
%
Had previously attended any diabetes class
yes
0
0
no
19
95
1
5
yes
6
30
no
14
70
0
0
healthy eating
3
15
exercise
4
20
pills
0
0
insulin
1
5
< Grade 8
3
15
Grade 9-10
2
10
Grade 11-13
5
25
some or completed college or university
5
25
I don't know
Had seen a dietitian or nurse for their diabetes
I don't know
Diabetes manage regimen *
Level of schooling
•12 clients used more than one method to manage their diabetes
Results –
Knowledge Gaps
Correct Responses
pre-class test
post-class test
question
n
(%)
n
(%)
1
11
55
16
80
2
10
50
11
55
3
13
65
18
90
4
3
15
4
20 (+ 5%)
5
8
40
18
90
6
5
25
14
70
7
3
15
11
55 (+ 40%)
8
17
85
18
90
9
2
10
3
15 (+5%)
10
8
40
10
50
11
20
100
20
100
12
14
70
19
95
13
10
50
18
90
14
10
50
17
85
Discussion
Question 4. A1C target
4. Your A1C should be:
a. less than 5
c. less than 7
b. less than 6
d. I don’t know
Discussion
Question 4. A1C target
3 clients (15%) correct on pre-class test
4 clients (20%) correct on post-class test
Improvement: 1 clients (5%)
Rothman et al: 8% of 217 participants knew the
normal A1C range11
Setter et al: A1C value poorly understood12
Discussion
Question 7. TC/HDL cholesterol ratio
7. Your cholesterol ratio (TC/HDL) should
be less than:
a. 2.0
c. 6.0
b. 4.0
d. I don’t know
Discussion
Question 7. TC/HDL cholesterol ratio
3 clients (15%) correct on pre-class test
11 clients (55%) correct on post-class test
Improvement: 8 clients (40%)
Cheng et al:
 cholesterol knowledge poor among population
 cholesterol education needed to improve
knowledge13
Discussion
Question 9. one aspect of healthy eating
9. Which of the following is part of healthy eating?
a. having 2-3 servings of vegetables and fruits each day
b. eating 2 meals each day, when hungry
c. having whole grains most of the time
d. I don’t know
Discussion
Question 9. one aspect of healthy eating
2 clients (10%) correctly on pre-class test
3 clients (15%) correct on post-class test
Improvement: 1 client (5%)
Falk et al: almost all of the 79 participants
classified vegetable and fruit as healthy food14
Study Limitations
►
Small sample size
►
Follow-up time line
►
Larger sample size and a longer follow-up
period needed to confirm findings
Conclusion
►
►
►
Improved diabetes knowledge
knowledge retained for one week
Consider revising class presentation regarding
A1C and healthy eating concept
References
1. Canadian Diabetes Association. The prevalence and costs of diabetes.
http://www.diabetes.ca/Section_About/prevalence.asp
2. American Diabetes Association 2000, statistics Canada 2000
3. Clement S. Diabetes self-management education. Diabetes Care 1995; 18: 1204-1214.
4. Ridgeway NA. Harvill DR. Harvill LM. et al. Improved control of type 2 diabetes
mellitus: a practical education/behavior modification program in a primary care clinic.
Southern Medical Journal 1999: 92(7):667-672.
5. Ridgeway NA. Harvill DR. Harvill LM. et al. Improved control of type 2 diabetes
mellitus: a practical education/behavior modification program in a primary care clinic.
Southern Medical Journal 1999: 92(7):667-672.
6. Leonard J. Outcomes of a Diabetes Education Program. Public Health Reports 1984:
99 (6): 575-579.
7. Miller C K. Evaluation of a food label nutrition intervention for women with type 2
diabetes mellitus. Journal of the American Dietetic Association 1999: 99: 323-328.
8. Chapman-Novakofski K. Karduck J. Improvement in knowledge, social cognitive theory
variables, and movement through stages of change after a community-based diabetes
education program. Journal of the American Dietetic Association 2005:105(10):1613
1616.
References
(continued)
9. Garrett N. Hageman CM. Sibley SD. et al. The effectiveness of an interactive small
group diabetes intervention in improving knowledge, feeling of control, and behavior.
Health Promotion Practice 2005: 6(3):320-328.
10. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood- glucose control with
sulphonylureas or insulin compared with conventional treatment and risk of
complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–
853.
11. Rothman RL. Malone R. Bryant B. et al. The Spoken Knowledge in Low Literacy in
Diabetes scale: a diabetes knowledge scale for vulnerable patients. Diabetes
Educator 2005: 31(2):215-224.
12. Setter SM. Corbett CF. Campbell RK. et al. A survey of the perceptions, knowledge,
and use of A1C values by home care patients and nurses. Diabetes Educator 2003:
29(1):144-152.
13. Cheng S. Lichtman JH. Amatruda JM. et. Knowledge of cholesterol levels and targets
in patients with coronary artery disease. Preventive Cardiology 2005: 8(1):11-17.
14. Falk LW. Sobal J. Bisogni CA. Connors M. et al. Managing healthy eating: definitions,
classifications, and strategies. Health Education & Behavior 2001:28(4):425-439.
Thank You
Comments and Questions