A survey conducted at a Veterans Administration Hospital to evaluate patient capability for self-management found that over 35 per cent of the patients interviewed lacked any formal training. Seventeen patients had been placed on insulin without formal instruction. Almost one half the patients who claimed to have attended training programs could not demonstrate adequate knowledge or skills in any of the major areas of self-care: insulin administration, urine testing, diet, foot care, and management of hypoglycemia and hyperglycemia. While patients with training were more knowledgeable than patients without training, the difference was slight. The results indicate the need for systematic analysis of patient knowledge and the evaluation of training programs on a continuing basis.

Confusion in the management of diabetes.

Evaluation of Patients' Knowledge of Diabetes Self-Care

The efficacy of our current educational programme for diabetic patients was assessed. Cognitive and behavioural tests were administered to 75 Type 1 (insulin-dependent) diabetic patients, aged ⩽ 30 years attending the Diabetic Clinic of the Mater Misericordiae Hospital, Dublin, Ireland. An overall deficiency in knowledge was evident. Fifty-one patients responded incorrectly to > 20% of the items tested. Twenty-nine patients lacked the ability to communicate a simple understanding of diabetes. Whereas most (70+) correctly identified the methodology of urinalysis, uncertainty was evident concerning appropriate action needed in response to such tests. Forty-nine did not know the significance of thirst and polyuria and 20 were unaware that hyperglycaemia could progress to coma. The ability to modify insulin dosage was poor as was the ability to use exchanges. Of patients aged ⩾ 20 years, those from the Dublin region scored better than did those from surrounding towns or rural areas, (r=0.5; p< 0.01). Regular out-patient attenders scored less well than nonattenders (r=0.24; p<0.05) but had better glycosylated haemoglobin levels (r=0.3; p<0.01). Gycosylated haemoglobin showed no significant correlation with level of knowledge held.

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Assessment of the outcome of an educational programme of diabetes self-care

A checklist of 22 items that diabetic persons need to perform correctly in order to carry out adequate home management was analyzed for 30 patients in an outpatient clinic Both a recording of correct performance (baseline assessment) and a reassessment 3--17 mo later were obtained for each item included in the study An 8 1/2% error rate occurred on reassessment Approximately one-third of the patients had an error rate of 10% or more No significant relationship was found between the percentage of error and age, interval between assessments, years of diabetes, or past performance on the checklist Nor did a majority of the errors occur on items that showed an error immediately before the correct baseline assessment This error rate is less than in reports not including a correct baseline performance However, it is high enough to indicate that reassessment is needed more frequently than is generally done

Deterioration of Diabetic Patients′ Knowledge and Management Skills as Determined During Outpatient Visits

The relationship between health locus of control type and preference for educational approach was examined in 89 diabetic adults, both hospitalized and ambulatory. In addition, subject personal and demographic variables were examined as they related to health locus of control type and preference for approach. No association was found between hypothesized health locus of control types and preferences for approach. A majority of all health locus of control types (64%) preferred a prescriptive approach. Hospitalized subjects and those who had not attended formal diabetes classes tended to believe that powerful other people had an impact on their health, while subjects who were ambulatory, and those who had previous formal instruction perceived themselves to be more responsible for their health; younger subjects also held high internal beliefs. Participatory approaches were preferred by younger subjects and those who had received formal diabetes instruction. The findings suggested that although educational approaches that maximize participation have been advocated, they did not appear to be the preferred approach. Although participatory approaches might actually be more efficacious in producing behavior change, the finding that people might not prefer them underscores the importance of tailoring educational methodology to individuals; age, place of instruction, and previous diabetes education are factors to be considered in tailoring programs.

Confusion in the management of diabetes.

Citations

Evaluation of Patients' Knowledge of Diabetes Self-Care

Assessment of the outcome of an educational programme of diabetes self-care

Deterioration of Diabetic Patients′ Knowledge and Management Skills as Determined During Outpatient Visits

Relationship of Participation Preference and Health Locus of Control in Diabetes Education

Education of the Patient with Diabetes

Related Papers (1)

A study of diabetic patients at home.