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Diabetes Education A Critical Review By Prof. Morsi Arab 2004

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

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Diabetes Education A Critical Review By Prof. Morsi Arab 2004

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  1. Diabetes EducationA Critical ReviewBy Prof. Morsi Arab2004

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

  3. Diabetes EducationDiabetes 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 courses1990-2003 - 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. Education Objectives Evaluation Strategy

  9. OBJECTIVES in Diabetes Education 1- Educate who? : Patient--Physician – Nurse .etc. – Public (awareness ).?2- Education Domains: a- Cognition (knowledge): levels? b- Skills c- attitudes3- From which background ?4- To achieve what ? to which level of competence ?

  10. The Background of the Educator1. Who educates : Physician , Nurse ,Dietitian other HC persons , professional Educator , Pier (precaution !!).2. Knowledge 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. Pt education : psychological acceptance and readiness to learn

  14. 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 thelearner’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 evaluationand followup 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.

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