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Restricted accessOtherFirst published November, 1999pp. 2-3
Restricted accessOtherFirst published November, 1999pp. 4-4
Restricted accessResearch articleFirst published November, 1999pp. 5-6
Restricted accessResearch articleFirst published November, 1999pp. 7-15PURPOSE
The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered.
METHODS
An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed.
RESULTS
Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA,, was the most frequently employed outcome measure, with little, if any, description of the interventions.
CONCLUSIONS
Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.
Restricted accessResearch articleFirst published November, 1999pp. 16-24PURPOSE
This article provides an overview of adult learner characteristics, with an emphasis on those characteristics studied in diabetes patient education research.
METHODS
A selected review of the conceptual and research literature on general adult education and adult learning was conducted, with particular attention to diabetes patient education studies.
RESULTS
Characteristics reviewed included learning styles, literacy level, age/aging, ethnicity or culture, gender, and knowledge. Studies of the learning style of group vs individual education indicated some positive benefits for group learning; questions remain about optimal size or periodicity. Studies evaluating the benefits of culturally specific interventions for diabetes management have yielded some information. Characteristics related to gender and age have been studied, but often in pilot or feasibility studies without the power to answer the study questions.
CONCLUSIONS
There continue to be many gaps in knowledge related to adult learner characteristics in diabetes education. Lessons from both general adult learning literature and patient education literature from other chronic diseases should be evaluated and incorporated. The complexities of these learner characteristics create challenges in designing studies. However, evidence to support the need for effective educational interventions is of great importance for implementing change in health care.
Restricted accessResearch articleFirst published November, 1999pp. 25-33PURPOSE
The purposes of this paper are to (1) review the literature on educational interventions for children and adolescents; (2) determine what kinds of interventions have been studied, how effective they are, and their outcomes; and (3) develop recommendations for further research in the field.
METHODS
An integrative literature review approach was used. Articles were included in this review if they met the criteria of being an empirical study reporting results of an intervention whose primary subjects were children with type 1 diabetes and/or their families, and published between 1980 and January 1, 1999. Of the 59 articles identified, 41 met these criteria.
RESULTS
The majority of the studies focused on adolescents. Results suggested that traditional educational interventions are successful in increasing knowledge but less successful in increasing quality of life or improving metabolic control. Psychosocial and family interventions (coping skills training) have been more successful in both quality-of-life and metabolic outcomes.
CONCLUSIONS
There is much work to be done to strengthen our understanding of what works under what conditions. More studies of younger children, minority youth, and families are needed using wellcontrolled experimental designs with adequate samples.
Restricted accessResearch articleFirst published November, 1999pp. 34-42PURPOSE
Literature search from 1985 to the present was performed using Web-based search engines to identify evidence-based studies of diabetes education.
METHODS
Twelve studies were identified in which a provider characteristic was defined as a discriminate variable associated with impact or efficacy of the education intervention. Provider was defined as all those participating in diabetes care and education (eg, patient, education and care teams, funding and policy agencies). The Certified Diabetes Educator credential also was described.
RESULTS
Specialty or discipline of the provider/care team, technology when used to assist providers, and physician practice patterns have been assessed. There is a paucity of research that assesses provider impact or the specific impact of provider characteristics on diabetes outcomes in a controlled and scientifically rigorous fashion.
CONCLUSIONS
Suggestions for evaluating provider impact based on literature concerning psychotherapy and healthcare education outcomes are: identify provider characteristics/attitudes/skills and link them to outcomes, define therapeutic alliance in diabetes care/ education and assess its contribution to outcomes; and use performance measures as provider characteristics.
Restricted accessResearch articleFirst published November, 1999pp. 43-51PURPOSE
In this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories.
METHODS
The vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories.
RESULTS
Both our vision and our theoretical assumptions should be articulated, discussed, debated, and studied.
CONCLUSIONS
Diabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education.
Restricted accessResearch articleFirst published November, 1999pp. 52-61PURPOSE
The purpose of this paper is to review the diabetes education literature that has emerged over the past 20 years to determine what we currently know about diabetes self-management interventions and their effectiveness in producing improved health outcomes.
METHODS
Findings of studies that were reported prior to 1990 were compared with findings of studies that have been conducted since 1990 to determine what recent changes and patterns in diabetes self-management education have occurred. Future directions in diabetes self-management research and practice were projected from these findings.
RESULTS
Most studies lacked adequate descriptions of the interventions tested, which precludes replication or application of the most effective strategies to clinical practice. Trends in interventions have evolved from education only to education plus behavioral models, with more attention given to interventions specifically for minority populations. The interventions that have been designed and tested seem to be longer, with more emphasis on simple, practical approaches to diabetes self-management.
CONCLUSIONS
The literature supports the effectiveness of diabetes education and behavioral interventions in improving psychosocial and health outcomes. The question of how to best achieve these improved outcomes continues to need further exploration.
Restricted accessResearch articleFirst published November, 1999pp. 62-73PURPOSE
The purpose of this paper is to explore how diabetes education produces change in self-care behavior.
METHODS
Published research on diabetes education relevant to behavior change was examined and a framework was formulated for the study of behavior change.
RESULTS
Research indicates that education improves patient selfmanagement, which in turn improves glycemic control and health status. Yet, there is relatively little information on what types of education produce what particular benefits for which types of patients. Moreover, we do not know the benefits of various forms of education (for selected groups) relative to their costs. Empirical studies of how education produces behavior change are few, but much preliminary work has been done to identify potential behavioral determinants that can be targeted by interventions. Theoretical models of behavior change have been advanced (eg, stages of change) but they have yet to be rigorously tested.
CONCLUSIONS
Initial answers to the research questions can be generated by conducting more sophisticated analyses of the type of data already being collected. However, obtaining complete answers to some of these questions will require more extensive data collection, including large-scale studies of multiple interventions in multiple patient groups.
Restricted accessResearch articleFirst published November, 1999pp. 74-88PURPOSE
The purpose of this paper is to review outcome measures used to evaluate diabetes self-management education and make recommendations for future research.
METHODS
Three perspectives were used: (1) the frequency with which different measures were collected prior to 1990 was compared with a sample of the 1997 to 1999 literature, (2) a multilevel pyramid model of psychosocial-environmental factors was used to evaluate the level of outcomes assessed, and (3) the RE-AIM evaluation framework was used to assess the public health impact of studies reported in the literature.
RESULTS
Knowledge and HbA1c measures are often collected to the exclusion of other, possibly more appropriate outcomes. Research has focused almost exclusively on individual or family level outcomes and paid little attention to effects at systems levels, such as neighborhoods, communities, or healthcare systems. More recent studies have been evaluating the reach of interventions, but more practice-oriented research needs to be conducted with representative patients, providers, and settings.
CONCLUSIONS
Much has been learned about the efficacy of diabetes selfmanagement and about measurement issues. Future research should now focus on effectiveness and generalization issues.