Barriers to attendance in diabetes education: a systematic review

Background: The use of structured patient education is widely acknowledged as one of the strategies for diabetes management in the UK. Nevertheless, the delivery of education programmes such as DAFNE (Dose Adjustment for Normal Eating) and DESMOND (Diabetes Education and Self-Management for On-going and Newly Diagnosed) in the primary care settings is often challenged by the attrition rate. Objective: The aim of this review was to identify barriers associated with attendance in diabetes education centres. Research design and methods: This secondary research uses a systematic literature review approach to examine the empirical evidence relating to non-attendance in diabetes education centres. Results: The findings of this study indicated various barriers ranging from personal problems and beliefs to lack of motivation and communication problems. Conclusions: There is a continuous need for on-going education and support for patients affected by diabetes regardless of the challenges posed by non-attendance

Barriers facing people with obesity and type 2 diabetes in weight control: a systematic review

Type 2 diabetes has both non-modifiable and modifiable risk factors, such as heredity and obesity respectively. Obesity or overweight is a key modifiable risk factor for type 2 diabetes. Therefore, weight control through non-pharmacological interventions such as diet and physical exercise are some of the important measures used to reduce the potential complications and mortality associated with diabetes. Although, there are various policies and guidelines to tackle obesity in the UK, controlling weight gain in clinical practice remains a challenge. This systematic review sought to examine the evidence relating to the barriers preventing people with obesity or overweight and type 2 diabetes from making lifestyle changes, such as increased physical activity and changes to diet as a means of weight control

The importance of diabetes specialist nurses

The epidemiology of diabetes and dramatic increase in the number of people with diabetes is well documented in literature and this calls for effective management of this long-term condition. A diabetes specialist nurse occupies a central position in caring for and supporting patients and their families over the course of the disease. In the day-to-day delivery of diabetes care, the diabetes specialist nurse (DSN) provides patient-centred care that meets the patient’s physical, social, and spiritual needs and they form the interface between the patient and other healthcare professionals. Due to the complexities of modern diabetic care, the roles and responsibilities of diabetes specialist nurses continue to evolve, however, this is accompanied by some challenges. Therefore, the employers, commissioners/providers, diabetes specialist nurses and higher education institutions have a vital role to play in dealing with the challenges confronting the development of this role

Individual versus group diabetes education: assessing the evidence

Diabetes remains a global medical problem. Among other management options, education plays a vital role in reducing the physical, social and economic burdens of the condition. Although awareness can be promoted through many media, providing structured patient education for people with diabetes is a key policy initiative. There are various teaching and learning strategies that can be used in diverse patient education sessions, and these can be delivered individually or through group learning. There is, however, no one-size-fits-all method of delivery. This article aims to present the arguments for and against individual and group education programmes for people with diabetes

Barriers to attendance at diabetes education centres: perceptions of education providers

A key global policy initiative in the management of diabetes is empowerment through education. However, implementation of policy in the context of healthcare delivery may be challenging at times and the delivery of multi-disciplinary education is not an exception. Objective: To explore practitioners view about factors associated with non-attendance and identify ways to break some of the barriers to advancing government policy of education for all patients with diabetes. Method: A qualitative approach was adopted using a focus group interview with practitioners in four hospital sites in South East of England. It involves Diabetes Specialist Nurses, Podiatrist and Dietician (n=7) and semi-structured individual interviews (n=3). Thematic analysis was used to analyse the data. Findings: Three main themes emerged (1) Practitioners associated barriers (2) Patients’ associated barriers and (3)Strategies to improve attendance. Conclusion: The findings indicated that the practitioners agreed on the need for improved appointment system, better resources such as more secretarial support to follow-up cases and offering more choice to the patients. Also each locality must consider the cultural needs and background of their patient. However, while some participants felt that non-attendance should attract a sanction, such as a fine, others disagreed

Exploring the challenges of patient flow in acute hospital settings: a Delphi study

There is a global increase in the number of emergency department (ED) admissions due to various factors such as ageing population, comorbidities, improved healthcare system, changing clinical practice, winter pressure and emergence of new diseases and infection such as the ongoing Covid 19 pandemic. The impact of rising demand for services include prolonged ED stay, delayed admissions, cancelled elective procedures, lack of bed availability, poor patient experience and pressure on other departments1,2,3,6. To address this growing problem, waiting time is a key measure of performance and a four-hour target for ED is recommended3,

Examining policy implementation for type 2 diabetes: exploring barriers and enablers associated with uptake of structured patient education

Background: Diabetes remains an incurable disease and as the search for a cure continues, the need to minimise complications and enhance the quality of life of patients is essential. A key UK policy initiative in the management of diabetes is empowerment through education. However, implementation of policy in the context of healthcare delivery in general may be challenging at times and the provision and uptake of diabetes education is not an exception. Aims: This thesis aims to examine the barriers and enhancing factors that are associated with the uptake of structured patient education for patients newly diagnosed with type 2 diabetes. Methods: The study used a sequential mixed methods approach. The data were collected using a focus group and face-to-face individual interviews of multiprofessionals delivering the education, a questionnaire/survey of patients and individual face-to-face interviews of referring practitioners working in GP surgeries within a PCT. Findings: Factors influencing non-attendance at diabetes education centres relate to barriers associated with the patients, practitioners and government regulations. The patients were affected by their healthcare beliefs and personal circumstances such as work patterns, childcare problems, forgetfulness, bad weather and ill health. The practitioners’ barriers were mainly around patient versus practitioner communication, inter-professional collaboration and administrative protocols. The barriers associated with the government directives relate to government regulations and funding issues. In contrast to barriers, the predictors of attendance are personal motivation, individual perceptions and beliefs coupled with the guidance given by the practitioners. Whilst it may be difficult to avoid non-attendance completely, positive steps to reduce nonattendance include enhanced communication, a positive pay-for-performance system and adequate support to develop a positive attitude towards diabetes education. Conclusion: The results indicate that barriers to attendance are multifactorial and complex; therefore, response to improve uptake requires diverse interventions

Sustainability of Borehole Water Schemes Through Community Participation in Ejigbo, Osun State

The study evaluates the contributions of community efforts to the borehole water supply schemes in Ejigbo Local Government Area (LGA). It examines the socio-economic characteristics of the respondents, enumerates the number of boreholes and their functionality, identifies the Agency that sponsored the provision of water scheme(s) and suggests measure of sustainance of the boreholes in the area. Data were collected from both primary and secondary sources. The primary source involves the enumeration of the total number of boreholes in the area, 250 structured questionnaires were administered using systematic random sampling method to collect information on the number of boreholes, their functionality, Agencies involved in the provision and community contributions.  Data gathered were analysed using both descriptive and regression statistics to affirm the degree of functionality of boreholes in the area. The study revealed that 36 boreholes were in poor condition and needed repairs to function effectively. Communities were not much involved in the maintenance of boreholes in the area, hence, there was no sense of belonging by the people for repairs and maintenance.  The study therefore recommends command approach in addition to the existing practice for sustainable water supply in the area. Keywords: water, borehole, functionality and sustainabilit

Managing epilepsy in the community: exploring the perspectives of community epilepsy nurse

Epilepsy care is known to have evolved dramatically worldwide, but achieving optimal care remains a challenge. In the field of neurological disorder, epilepsy is one of the most disabling diseases and it has a significant personal, social, and economic impact1. People with epilepsy often have multiple healthcare needs and the current international healthcare policy advocate the adoption of a holistic approach to provide patient centered care (PCC) 1. The Epilepsy specialist nurse (EN) has a vital role to play within the epilepsy care team and they help to reduce unnecessary use of hospital facilities and enhance the quality of life of the patients

Src Dependent Pancreatic Acinar Injury Can Be Initiated Independent of an Increase in Cytosolic Calcium

Several deleterious intra-acinar phenomena are simultaneously triggered on initiating acute pancreatitis. These culminate in acinar injury or inflammatory mediator generation in vitro and parenchymal damage in vivo. Supraphysiologic caerulein is one such initiator which simultaneously activates numerous signaling pathways including non-receptor tyrosine kinases such as of the Src family. It also causes a sustained increase in cytosolic calcium- a player thought to be crucial in regulating deleterious phenomena. We have shown Src to be involved in caerulein induced actin remodeling, and caerulein induced changes in the Golgi and post-Golgi trafficking to be involved in trypsinogen activation, which initiates acinar cell injury. However, it remains unclear whether an increase in cytosolic calcium is necessary to initiate acinar injury or if injury can be initiated at basal cytosolic calcium levels by an alternate pathway. To study the interplay between tyrosine kinase signaling and calcium, we treated mouse pancreatic acinar cells with the tyrosine phosphatase inhibitor pervanadate. We studied the effect of the clinically used Src inhibitor Dasatinib (BMS-354825) on pervanadate or caerulein induced changes in Src activation, trypsinogen activation, cell injury, upstream cytosolic calcium, actin and Golgi morphology. Pervanadate, like supraphysiologic caerulein, induced Src activation, redistribution of the F-actin from its normal location in the sub-apical area to the basolateral areas, and caused antegrade fragmentation of the Golgi. These changes, like those induced by supraphysiologic caerulein, were associated with trypsinogen activation and acinar injury, all of which were prevented by Dasatinib. Interestingly, however, pervanadate did not cause an increase in cytosolic calcium, and the caerulein induced increase in cytosolic calcium was not affected by Dasatinib. These findings suggest that intra-acinar deleterious phenomena may be initiated independent of an increase in cytosolic calcium. Other players resulting in acinar injury along with the Src family of tyrosine kinases remain to be explored. © 2013 Mishra et al