Learning difficulties of diabetic patients: a survey of educators

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Abstract

This study was designed to shed light on the learning difficulties of diabetic patients. An open-ended questionnaire was sent to 85 health care professionals working in the field of diabetes and nutrition who had been trained in patient education techniques. They were asked to describe the skills that were the easiest to teach patients and those that patients mastered the best, as well as the skills they found hardest to teach patients, those that patients mastered the least and those that gave rise to errors persisting after the patients education was completed. On the whole, the results showed that the educators found it easy to teach techniques: patients mastered procedures well and made few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving (involving multiple variables). Based on these findings, the authors discuss the notions of learning complexity and the time needed for successful patient education.

Introduction

Patient education has been an integral part of diabetes treatment for over 30 years. In all countries, it is agreed that educating diabetic patients is effective, particularly in reducing the number of hospitalizations, improving glycemic balance and reducing or delaying complications 1, 2, 3. In France, nearly all diabetes departments have instituted patient education programmes, but they are not uniform and vary from team to team [4]. We showed in an earlier study that diabetes educators employ a wide range of teaching approaches, although a few programme models tend to predominate [5].

Consequently, the real problem today is not to demonstrate the effectiveness of diabetic patient education, but to determine which pedagogical approaches are more effective [6].

A recent survey by Albano [7]of the “Medline” literature published over the last 10 years (1986–96) found that, of 57 401 references on diabetes, 9111 mentioned patient education, 946 focused on the education of diabetic patients and just 38 presented random experimental studies. In those 38 experiments, the general objectives were defined in 57% of the cases, and the specific objectives, in 43%. The teaching methods were interactive in 60% of the cases, and multi-disciplinary teams provided the instruction in 51%.

Another question of interest to educators concerns the amount of time required to educate IDDM and NIDDM patients, both initially and in continuing education. A recent survey [6]of 400 caregivers indicated that 8 to 10 h were needed for the initial education of IDDM patients, and 12 to 14 h for their follow-up training. The initial education of NIDDM patients normally required 5 to 6 h and their continuing education, 8 to 10 h.

Our approach to the problem of the right education for diabetic patients (IDDM and NIDDM) is somewhat different. Independent of programme type or training duration, we wondered which skills were the easiest to teach patients, which were the hardest to teach them and which ones diabetics were still the weakest in after their education was completed. The purpose of this study was to determine the relative difficulty of achieving the various objectives of diabetic patient education, so that health professionals can rethink their teaching methods and better estimate the time needed for it. Thus, we surveyed a sample of 85 French caregivers, all involved in the education of diabetic patients.

Section snippets

Methods

The group surveyed consisted of 85 respondents. Their professional breakdown was as follows: (i) seven physicians; (ii) six dieticians and (iii) 72 nurses.

For inclusion in the sample of health care professionals, a caregiver had to: (1) work in the field of diabetes and nutrition; (2) be actively involved in patient education and (3) have undergone formal training in diabetic patient education.

Personally-addressed questionnaires were sent to 212 diabetes/internal medicine and diabetes

Results

The analysis of responses produced several interesting findings (Table 3). On the whole, management of their illness seems to be the hardest thing to teach diabetes patients (cited 96 times). Patients showed the poorest mastery of management skills (cited 85 times), which gave rise to a large number of persisting errors (cited 60 times) after training was completed.

The complexity of learning to adjust insulin doses is what make diabetes management so difficult to instil. Insulin adjustment was

Discussion

While this study had certain limitations, chief among them being the fairly small number of respondents, the percentage of returned questionnaires is acceptable for the type of survey method employed (i.e., mailed, open-ended questionnaires) 8, 9. The method was chosen in order to give caregivers time to think and prepare considered written responses to the questions. Given the high workload of medical teams during the day, the authors felt that any other survey method (telephone interviews for

Conclusion

Several authors 17, 18have pointed out how difficult it is to educate patients, given their diverse backgrounds, varying degrees of motivation and differing learning abilities. This study focused solely on the pedagogical aspects of patient education and, in particular, on learning difficulties as perceived by patient educators.

The greatest problem seems to lie in going beyond the transmission of information and instilling lasting and reliable behaviours. According to the patient educators

Acknowledgements

The authors would like to thank Dr. Jean-Luc Bosson of the Service d'Information Médicale at the Centre Hospitalier Universitaire de Grenoble (France) and the Institut de Perfectionnement en Communication et Education Médicales (IPCEM), 13 Rue Jean Jaurès 92807 Puteaux (France), for their help.

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  • Adjusting insulin doses: From knowledge to decision

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    A failure of the therapeutic education: patients do not adjust the insulin doses because they did not learn how to do it or because they did not understand the rules which were explained to them, or because they are not sure enough of their knowledge, uncertainty entailing indecision [7,8]. Further, in fact, it is clear that the therapeutic education of the patients is not restricted to a transmission of knowledge, but is also aimed to elicit behaviors from the patients [2]. The absence of adjustment of the insulin doses, in this frame, does not involve only cognitive factors, but may also be related to the following different reasons.

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