Cooper, H
(2001)
Capturing the impact of patient education for people with Type 2 diabetes mellitus.
PhD thesis, University of Liverpool.
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Abstract
The prevalence of Type 2 diabetes mellitus is increasing worldwide and with it, the demands on heath service resources. As the long-term outcomes of this disease are dependent upon reducing lifestyle risk factors, together with effective treatment and screening strategies, much of the responsibility for diabetes management ultimately resides with the patient. Therefore patient education is a key part of the care of this population. A trial of an empowerment based health education programme was underpinned by the theories associated with health protective behaviour and those associated with adult learning. These align patient education to an experiential learning process within which beliefs about self-efficacy and the effects of social-environmental influences are central to outcomes. This view was compatible with current health care policies which see patients taking a more active and informed role in their disease management. The trial utilised a randomised controlled wait-list design to allow for the ethical limitations of excluding patients from educational treatment, and permitted collection of data over a short- and long-term period. A qualitative approach to data collection, using symbolic interactionism, was also integrated into the clinical trial. The two types of data were treated as complementary so that the outcomes of the trial relied upon detailed exploration of how they complemented each other. Eighty-nine patients were recruited from three diabetes centres. All patients recruited were blindly randomised to a 'Look After Yourself education programme. Clinical, behavioural and psychological outcomes were measured at six and twelve months. The relationship between these, the content of the intervention and participants' perspectives was assessed through ten focus group interviews. The combined results showed that the educational intervention had modified participants' personal models of diabetes by increasing their knowledge and understanding, by clarifying their beliefs and by changing their attitudes toward the disease and its management. It facilitated the acquisition of skills and prompted movement into the behaviour change cycle for the majority of those taking part, regardless of socio-economic status. The impact of these changes upon clinical outcomes was most effective where participants perceived their risk factors to be greatest. These findings supported the production of a framework for guiding nursing intervention to enhance patient self-management of diabetes. To adhere to such a model of care, however, the trial highlighted the need to expand the biomedical orientation to patient education so that it allows for patients' self-perceived needs. This demands integration of the medical and behavioural sciences into the practice of diabetes care and recognition of the need to support patients in their lifelong task of maintaining their own health. It recognises that care for chronic illness is an inherently different social enterprise than is care for acute illness. The findings have therefore highlighted the training needs for health professionals so that they can develop the skills that can enhance this process. Whilst these conclusions acknowledge the importance of continuing education and support for patients, such clinical practice will rely upon tailoring nursing intervention to the outcomes of a diabetes-specific assessment instrument. In this way, educational referral can become an integral part of a patient's treatment profile. Only then might health professionals authenticate a culture that supports patient choice so that they can take greater control over their health.
| Item Type: | Thesis (PhD) |
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| Additional Information: | A central tenet of diabetes care concerns facilitating self-management through patient education, but how education should be delivered, and any long-term impact remains uncertain. This thesis describes an RCT of an empowerment-based educational programme for people with Type 2 diabetes. The aim of the trial was to understand how education influences outcomes in the context of patients’ everyday lives. Eighty-nine patients were recruited from three diabetes centres in the North West of England. All patients were randomised to an evidence-based ‘Look After Yourself’ education programme using a controlled wait list trial design. This method was chosen to overcome ethical constraints of denying education to a control group of patients. Clinical, behavioural and psychological outcomes were measured at 6 and 12 months. The relationship between these, content of the intervention and participants’ perspectives was assessed through ten focus group interviews. Results at 6 months showed significant changes in HbA1c (p=0.005), but not at 12 months (p=0.08). Significant improvements in attitudes towards diabetes were noted at 6 months (p=0.04) and at 12 months (p=0.01). No significant changes in self-monitoring behaviours were detected at 6 months but changes were highly significant at 12 months (p=0.002). Positive improvements in diet and exercise behaviour were noted but these did not reach significance. The focus group data showed how intervention had helped participants enter the behaviour change cycle and how relationships with health care professionals are critical to the long-term results of this outcome. The study highlighted that long-term success in relation to patient education should be identified in terms of a client’s progress toward change, and health professionals need to develop the skills which enhance this process. It also identified the importance of using combined research methods to capture the impact of patient education. It showed how different theoretical approaches to research presented different ways to ask related research questions and provided different types of answers and different messages for health care delivery. It provided evidence to show that although technical-rational knowledge has led us to understand more of the patho-physiology of chronic diseases, it has often been at the cost of understanding patient management and acknowledging the individuality of each person’s experience. |
| Uncontrolled Keywords: | Diabetes mellitus, patient education, empowerment, self-management, combined research methods |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 23 Oct 2023 10:18 |
| Last Modified: | 23 Oct 2023 11:19 |
| DOI: | 10.17638/03175995 |
| Copyright Statement: | Copyright © and Moral Rights for this thesis and any accompanying data (where applicable) are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3175995 |
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