1. Diabetes Education A Critical Review By Prof. Morsi Arab 2004

2. Targets and Pathways in Diabetes Education * physician * Nurse Patient * pharmacist * understanding Education * Specialized * Self manage Planner - Diet * avoid compl. - exercise * improve quality - foot care, etc of life - Prof. Educator - volunteer - Pier education (in groups) - family member ( eg. Mother)

3. Diabetes Education Diabetes Education = 50% of success in management (control) of Diabetes and prevention (1ry, 2dry and 3ry ) of its complications

4. Historical Development of Diabetes Education (Global) - In Portugal (Dr. Roma): first education programme. - Joslin USA,1922: Ed. Classroom - British Diab. Ass.,1925 : Information – Skills-- attitude. - Role of Nurse in Ed, 1980-82,Diab. Care & Lancet.

5. * Indicators of the value of Education : - Hospital admissions (for DKA, foot, ulcers & hypoglycaemia). - Incidence of amputations - Effect on glycaemic control …..??? * WHO and IDF: - World Diabetes Days. - Regional Declarations ( St. Vincent – San Jose- Alexandria ). - IDF Education Foundation.

6. Historical Dev. Of Diab. Ed. In Egypt 1962-1970 : Interactions with Brit. D.A. (UK) and Dept. of Med. Ed. (USA). 1970-1980:- Alex. D. A. (First pt.ed.prog ) - Acquiring professional ed. technology : * WHO training (Shiraz) * USA North Carolina * USA Univ. of Illinois

7. 1980-1990 Extensive patient and physician courses 1990-2003 - first Nurse Ed. Prog. 1991 - collaboration with Min. of Health for Nurse Training Prog. - Pharmacist Education Prog. - Combined courses in Governorates - Collaboration with IDF Ed.Foundation * video films in Arabic. * Nurse Guide Book. - The Alexandria Declaration on patient education

8. Objectives EvaluationStrategy Education

9. OBJECTIVES in Diabetes Education 1- Educate who? : Patient--Physician – Nurse.etc. – Public (awareness ).? 2- Education Domains: a- Cognition (knowledge): levels? b- Skills c- attitudes 3- From which background ? 4- To achieve what ? to which level of competence ?

10. The Background of the Educator 1. Who educates : Physician, Nurse,Dietitian other HC persons, professional Educator, Pier (precaution !!). 2. K nowledge of contents (diabetes). 3. Professional Education skills (viz) 4. Member in Education Team (no controversies). * The biased educator.

11. The Background of The Learner 1. His General Knowledge and ed.(eg.illiteracy) 2. His Specific knowledge and ed. in diabetes: * not necessarily correlated with his gen. Kn. or ed. * relation to the Duration of Diab. ? - not necessarily nil at the onset - and not necessarily satisfactory with long durations. (usually distorted ).

12. - The Background of The Learner (cont.) 3.His psychological “Stage of Acceptance” (viz)… 4.His diabetes status : (controlled / uncontrolled-- complicated– handicapped ?) 5.His basic attitudes,perception and belief about: cause of his illness--consequences –value of treatment-- cost/benefit – slavery to specific habits (eg. smoking).

13. Not concerned, unlikely to benefit from education I am not sick1- Denial Mis-interprets & distorts informat. given. Fails to remember Why me?2- Revolt Ready to learn. Demands to learn OK, but I know what to do 3-Bargain Pt education : psychological acceptance and readiness to learn

14. Also ready to learn I am sick, I shall take Rx,but shall I be able to cope? 4- Depression Most receptive : attentive, ready to discuss,accepts suggestions & corrections I shall live with it …… 5- Acceptance Pt education : psychological acceptance and readiness to learn (cont.)

15. A-V Aids in Pt Education (Diet sheet--Handbooks --Pamphlets --Slides – Video tapes –Self evaluation check lists – Computer prog. with Q & A, etc) 1.selected to meet the objectives and match the learner’s abilities. 2. avoid : too complex leaflets – long video prog. (7-10min…. with only 2-3 concepts) contradictory information – Foreign language ( or badly translated). 3. should not be intended to escape from direct talking to people.

16. Education Skills : - In one-to-one Education: (listen, motivate,individualize to stage, not too much,reward more than blame,etc.) - In Group Education: - Size of the group. - Group dynamics (+ve & -ve behaviours) - Educate not teach (active participation)

17. Education Skills (cont.) : - Clever use of AV aids - Pamphlets - Booklets - Slides - Video tapes - Computer programmes - Pitfalls in using Media for Mass Education.

18. Education to change attitudes: The uncompliant patient resents Education: 1- At the early stages of:denial protest & refusal. 2- Slave of a habit : smoking, exercise, eating. 3- Adherence to background belief about the cause of his diab., his health locus of control (external forces or inside self ?).

19. The uncompliant patient (cont.) 4- Depression after: - unachievable goals (eg in body wt). - repeated failure of glycaemic control. 5- Transient stress by:social,economic or intercurrent illness. N:B: Changing attitudes should be individualized.

20. Physician Education in Egypt Indicators of inadequacy : * Indirectly, from studies on patients status: 1- High prev. of glycaemic uncontrol. 2- Uncontrol of other parameters e.g. hypertension,hyper-cholestrolemia.etc 3- High prevalence of hospital admissions for complications.DKA,Hypo,Foot inf, etc

21. Physician Education in Egypt (cont.) Indicators of inadequacy : 4- Reflection on poor patient information (e.g about syringes, etc). N.B.: There are no direct studies on the relation of implementation of education prog.to physician’s achievements of ed. skills.

22. Common Causes of failure in patient Education 1- Objectives unsuitable to cultural background, attitudes, beliefs, psychological status,stage of illness, etc of the learner. Non achievable objectives. 2- Educator without proper educational skills and/or sufficient knowledge of the programme content. 3- Lack of, maldistribution or wrong selection of ed.resources (personnel, equip., aids, etc)

23. Causes of inadequacy of physician’s Education outcome: 1. Incoordination of Education programmes (place and time maldistribution ). 2.Lacking of professional educational skills. 3. Wrong selection of objectives. 4. Poor cost-benefit (Education Parties ): * minimal attendance * false certification * too short courses

24. Causes of inadequacy of physician education ( cont.) 5.Unsuitable content (confusing basic training with high tec. theoretical knowledge ). 6. lack of evaluation and follow up of outcomes.

25. Causes of inadequacy of physician education ( cont.) 7.Biased Education ( conflicts of interest ). 8.Lack of national collaboration to produce: * unified guide-lines for ed. prog. * unified assessments of outcomes. 9.Lack of accountability to specific reference authorities.