Transcript Diabetes Education A Critical Review By Prof. Morsi Arab Targets and Pathways in Diabetes Education Education Planner * physician * Nurse * pharmacist * Specialized - Diet - exercise - foot care,

Diabetes Education
A Critical Review
By
Prof. Morsi Arab
2004
Targets and Pathways in Diabetes Education
Education
Planner
* physician
* Nurse
* pharmacist
* Specialized
- Diet
- exercise
- foot care, etc
- Prof. Educator
- volunteer
- Pier education
(in groups)
- family member
( eg. Mother)
Patient
* understanding
* Self manage
* avoid compl.
* improve quality
of life
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 ).
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
courses
1990-2003 - 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
Education
Objectives
Evaluation
Strategy
OBJECTIVES in Diabetes Education
1- Educate who? :
Patient--Physician – Nurse .etc. –
Public (awareness ).?
2- Education Domains:
a- Cognition (knowledge): levels?
b- Skills
c- attitudes
3- 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).
Pt education : psychological acceptance and
readiness to learn
1- Denial
I am not sick
Not concerned,
unlikely to benefit
from education
2- Revolt
Why me?
3-Bargain
OK , but I know
what to do
Mis-interprets &
distorts informat.
given. Fails to
remember
Ready to learn.
Demands to
learn
Pt education : psychological acceptance and
readiness to learn (cont.)
4- Depression
5- Acceptance
I am sick , I shall
take Rx,but shall I
be able to cope?
I shall live with it
……
Also ready to
learn
Most receptive :
attentive, ready to
discuss ,accepts
suggestions &
corrections
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.