Empowering T2D Patients through Education

A Review of Education Models for Improving Knowledge T2D Self-Management

Various health organizations globally have recommended patient education as an effective tool for empowering and enhancing self-care among T2D patients. For instance, the National Institute of Clinical Excellence (NICE) has shown its support for patient education by proposing various patient education models for diabetes, thereby developing a definitive structure through which a flexible and comprehensive patient education for type two diabetes can be delivered (NICE 2003). Besides, the developed models (e.g. the Diabetes X-PERT Program and The Dose Adjustment for Normal Eating, DAFNE) were deemed to be responsive to the individual’s cultural and educational needs (Sabrina Cecconi, 2016). But the fact that these models were developed in the UK raises a question as to whether they are directly applicable in other cultures, or in countries with different ethnic groups, or whether they require some form of cultural adaptation before they can effectively be implemented. This perspective is especially backed by the findings of Brown et al (2002) who conducted a randomized repeated measures study In the Texas –Mexico among diabetic adults of age 35 to 70 and found that the application of Diabetes self-management education (DSME) programs in conjunction with cultural adaptation had positive health outcomes. The study involved bilingual Mexican-American community workers, nurses and dieticians, thus the intervention was deemed to be culturally competent in terms of social emphasis, diet, language, and health beliefs.

Whereas there are various pieces of literature highlighting the effectiveness of various T2D self-management education intervention programmes, it is important to evaluate the cultural acceptability of any of these programs before deciding on which one to implement. In doing so, we will consider how various interventions have previously been culturally adapted to incorporate newer and better ways of intervention delivery that are culturally sensitive. Besides, evaluating the cultural acceptability of each program by reviewing existing literature is important in determining how previous researchers have culturally adapted the interventions to fit the specific population group they are targeting. We now turn to a review of the literature on various frameworks used for cultural adaptation of the intervention and the outcome of each culturally adapted intervention.

The following table highlights the reviewed interventions and their respective cultural adaptations that would be of interest to the proposed interventional study:

All of the above studies were conducted using a face-to-face delivery method, and no studies used the method of online screening. The number of sessions and the time taken to complete the sessions have not been recorded in all the studies. These studies used interventions that focused on monitoring, self-care, assessment, diet, physical activity and antidiabetic medications, which helped to improve self-management behaviours and outcomes. The majority of these studies found a statistically significant improvement in the biomedical data following a self-management intervention. There was some evidence that multiple lifestyle modifications were beneficial for the promotion of diabetes self-management. However, these studies lacked appropriate theoretical models, which hindered their effectiveness and reliability. Only one study by Mohammed et al. (2013) used the concepts of self-empowerment and self-management.

Cultural adaptation is not just a tool for translating language (Sabrina Cecconi, 2016), and most of the studies described the cross-cultural adaptation that was made for the language used in the intervention. Previous research has also suggested that patient involvement, cultural adaptation, family involvement and individualisation are important factors in the development of interventions seeking to increase self-management among patients with diabetes. However, it is difficult to directly attribute the studies’ outcomes to the various cultural adaptations that were made throughout each study. The proposed study will take such considerations into account because they relate to important cultural aspects that can affect the intervention’s effectiveness. For instance, it is crucial to take into consideration the various cultural occasions when self-management is required – some Muslim occasions (e.g. religious events and celebrations) affect diabetic health through the type of food or drinks consumed (Gupta et al., 2017).

Moreover, we believe that sharing knowledge about the participants’ self-management is important because it gives self-management insights from the participants’ cultural perspective. ​It became difficult for all of the above-mentioned studies to manage long-term effectiveness. Thus, there is a need for continuous evaluation and follow-up for the long-term benefit of these programmes. Skills training and support are the two major factors linked to the self-assessment of type 2 diabetes (Alasmary et al., 2013), but the interventions in the above studies focused on proper diet, medications, regular exercise and lifestyle changes, rather than skills, attitude and support. Although the theoretical framework was considered, it was not appropriately organised with the patients’ demographics, socioeconomic status, cultural values, nutritional choices or physical and mental well-being (Al-Shahrani et al., 2012). The framework also failed to consider the personal characteristics of the patients and how these could enhance self-efficacy in relation to disease management.

In conclusion, structured educational programme interventions appear to have a positive impact on patients with type 2 diabetes in Saudi Arabia (Alhaiti, 2015). DSME is widely recognised as an essential element of diabetes care. However, DSME is largely unknown in diabetes education and care in Gulf Cooperation Council (GCC) countries (Thamer, 2017). This is particularly important because no structured group-based education currently exists or is applied in the region (Mohammed et al., 2013) .Yet, existing literature does not give a clear indication of why other models of education have had little adoption in this region. . We therefore intend to adopt some of the strategies and frameworks adopted by the previous studies to implement the proposed educational intervention such as the teaching methods and materials, and human resources.

REFERENCES

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Haas L., Maryniuk M., Beck J., Cox C. E., Duker P., Edwards L., . . . Youssef G. (2013). National standards for diabetes self-management education and support. Diabetes Care, 36 (Supplement 1), S100– S108.

Brown S. A., Garcia A. A., Kouzekanani K., & Hanis C. L. (2002). Culturally competent diabetes selfmanagement education for Mexican Americans: the Starr County Border Health Initiative. Diabetes Care, 25(2), 259–268. PMID: 11815493

Abdul Kareem A. R., & Sackville M. A. (2009). Changes of some health indicators in patients with type 2 diabetes: A prospective study in three community pharmacies in Sharjah, United Arab Emirates. Libyan Journal of Medicine, 4(1), 29–38.

Al-Shahrani A. M., Hassan A., Al-Rubeaan K. A., Al Sharqawi A. H., & Ahmad N. A. (2012). Effects of diabetes education program on metabolic control among Saudi type 2 diabetic patients. Pakistan Jour- nal of Medical Sciences, 28(5), 925–930.

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Sabbah, K. O. A., & Al-Shehri, A. A. (2014). Practice and perception of self-management among diabetics in Taif, KSA: impact of demographic factors. International Journal of Medical Science and Public Health, 3(3), 277-285.

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Alhaiti A, Jones L, Qasim A, Lenon G. (2015). The effectiveness of self management education with Type 2 diabetes patients in Saudi Arabia: Systematic literature review. International Journal of Current Research, 7(10), 21854–21860.

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