The obstacles to diabetes self-management education and support from healthcare professionals’ perspectives: a nationwide survey

Lukana Preechasuk,1 Pornsri Sriussadaporn,1 Supawadee Likitmaskul1,21Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: This study identified the obstacles to diabetes self-management education and support (DSMES) from healthcare professionals’ perspectives in Thailand.Patients and methods: A cross-sectional survey was conducted at 613 hospitals throughout Thailand from December 2016 to March 2017. A self-completion questionnaire on the characteristics of, and obstacles to, diabetes education was sent to administrators, doctors, and diabetes educators (DEs). The views of DEs at public and private hospitals on the characteristics of diabetes education were compared. The obstructing factors reported by administrators, doctors, and DEs were also analyzed.Results: The overall response was 76.6%; the response rates of DEs, doctors, and administrators were 85.6%, 58.9%, and 46.5%, respectively. Although the respondents reported that 75% of patients received diabetes education, only 30% of the DEs believed it was successful. An individual-patient education approach was used by 95.1% of public and 81.4% of private hospitals. The median durations of the individual education sessions were 15 (IQR 10, 28) and 30 (IQR 15, 30) minutes for public and private hospitals, respectively. The DE workload at public hospitals was 3 times heavier than at private hospitals (60 [IQR 30, 140] vs 20 [IQR 10, 33] patients per week; p<0.001). Obstacles to diabetes education were a lack of time due to other duties, a lack of skills in assisting patients with behavior change, inadequate DE numbers, patient disinterest in diabetes education, and patient reluctance to change unhealthy behaviors.Conclusions: High workloads, unclear DE roles, and a lack of DE skills to support patients with behavior change are the primary obstacles to diabetes education.Keywords: diabetes education, diabetes self-management education, obstacl

Psycho-educational interventions for children and young people with type 1 diabetes

Background A systematic review of the literature in 2000 revealed numerous methodological shortcomings in education research, but in recent years progress has been made in the quantity and quality of psycho-educational intervention studies.Summary of contents This review focuses on diabetes education programmes developed for children, young people and their families in the past 5 years. A comprehensive review of the literature identified 27 articles describing the evaluation of 24 psycho-educational interventions. Data summary tables compare the key features of these, and comparisons are made between individual, group and family-based interventions. Effect sizes are calculated for nine of the randomized studies. Three research questions are posed: firstly has the recent literature addressed the problems highlighted in the previous review; secondly is there sufficient evidence to recommend adaptation of a particular programme; and, finally, what do we still need to do?Conclusions Progress in the quality and quantity of educational research has not resulted in improved effectiveness of interventions. There is still insufficient evidence to recommend adaptation of a particular educational programme and no programme that has been proven effective in randomized studies for those with poor glycaemic control. To develop a range of effective educational interventions, further research involving larger sample sizes with multicentre collaboration is required