A taxonomy for diabetes educational interventions

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Abstract

Diabetes education is a cornerstone of diabetes self-care management. Despite terrific progress in refining educational interventions, the diabetes literature continues to contain substantial inconsistencies in reporting the elements of educational interventions. This unnecessary variation in the quality of reporting has led to difficulties in understanding the results of educational research in diabetes. We provide a taxonomy that should prove helpful, both in the conceptual design of diabetes educational interventions and in the reporting of those interventions. An application of this taxonomy to 30 diabetes educational randomized controlled trials is presented to highlight the extent of variation in diabetes educational interventions.

Introduction

“Patient education is a planned learning experience using a combination of methods, such as teaching, counseling, and behavior modification techniques which influence patients’ knowledge and health and illness behavior” [1]. Although Dr. Bartlett’s Delphi Group definition of education is clear and provides an important foundation for reporting findings, investigators continue to struggle to adequately characterize diabetes education when reviewing the literature [2]. Inspecting the literature reveals inconsistencies in the nature and reporting of the elements of educational interventions leading to difficulties in understanding the results of educational research in diabetes. Inadequacies of reporting have been a major obstacle to providing summary effects of diabetes education [3], [4]. Moreover, variations in study population, study design, statistical power, nature of the intervention, and outcome measured, have made a coherent assessment of the impact of diabetes education difficult to discern [5].

Undoubtedly, this heterogeneity has contributed to disagreements about the impact of diabetes educational interventions. Although early investigators questioned the value of educational interventions in diabetes [6], recent efforts have clarified the necessity of diabetes education [7]. There seems little doubt within the diabetes community that diabetes education is necessary, yet not always sufficient, even if it is difficult to state with clarity what exactly is diabetes education. A recent summit of diabetes educators highlighted these difficulties and stressed the importance of better defining the ‘core elements’ of diabetes education [8]. While others have commented on the problem of adequately reporting elements of diabetes education [9], few concrete solutions have been suggested to remedy the problem save the admonition that “we should do better.”

While the present article does not attempt to establish the ‘necessary’ components of diabetes education, we sought to advance the current state of knowledge by characterizing the variables within diabetes education interventions. We sought to characterize the variables, highlight the extent of variation, and, equally importantly, give future investigators a template for planning and reporting their work.

Section snippets

Literature search

We searched MEDLINE, CINAHL, healthSTAR, ERIC, Science Citation Index, PsycINFO, and CRISP databases using the key words diabetes mellitus and patient education. The review was limited to English language studies published between 1990 and May 1999. We further limited the review by study design, only randomized controlled trials, as well as excluding studies that did not include a measure of glycemic control as an outcome. Studies that were performed solely in the hospital or where patients

The final taxonomy

The setting, delivery, teaching method, content, provider, tailoring of intervention to assessment, modifying the intervention in follow-up, intensity of intervention, and whether a baseline ‘supplement’ is given represent nine variables that characterize practical and theoretically interesting variables on which diabetes educational interventions differ (Table 1). These variables represent a description of readily identifiable dimensions of educational interventions.

The variation in 36

Discussion

Terrific progress has been made over the last two decades in improving the care provided to patients with diabetes. Refinements in educational approaches so as to include behavioral components have made substantial contributions to improved patient care [45]. Educators no longer simply dispense information, but increasingly consider how best to ‘empower’ patients with diabetes [16], [46], [47]. Concern for patient well-being, intellectual curiosity, and pragmatic issues [48], [49] are directing

Practice implications

A taxonomy to systematically characterize the present variation in diabetes education has been described. We call on editors and authors to utilize this taxonomy, or a later iteration after the research community has had an opportunity for critical evaluation, for the purpose of reporting findings. Failure to advance on the current state of reporting will only undermine our ability to critically test hypotheses about educational interventions. Consideration of this taxonomy will enhance both

Acknowledgements

This project was supported in part by NIH Grant No. P60-DK20593.

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