Lasting impact of an implemented self‐management programme for people with type 2 diabetes referred from primary care: a one‐group, before–after design

• Published in: Scandinavian journal of caring sciences Vol. 31; no. 4; pp. 789 - 795
• Main Authors: Fløde, Mari, Iversen, Marjolein M., Aarflot, Morten, Haltbakk, Johannes
• Format: Journal Article
• Language: English
• Published: Sweden Wiley Subscription Services, Inc 01.12.2017
• Subjects: Adult; Clinical outcomes; Clinical research; counselling; Diabetes; Diabetes Mellitus, Type 2 - therapy; Diabetics; Disease management; Female; Health behavior; health education; Humans; Intervention; Knowledge; Male; Management development programmes; medical nursing; Middle Aged; Norway; Nursing; Patient education; patient participation; Primary care; Primary Health Care; Quantitative analysis; Questionnaires; Referral and Consultation; Self Care; Self-efficacy; Selfmanagement; Type 2 diabetes mellitus; Norway; counselling; health education; medical nursing; diabetes; patient participation
• ISSN: 0283-9318; 1471-6712
• DOI: 10.1111/scs.12398

Background Research interventions in uniform clinical settings and in patients fulfilling well‐defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self‐Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented. Objectives To examine the impact of an established group‐based DSME in unselected people with type 2 diabetes referred from primary care. Method A one‐group, before–after design was used for assessments before, immediately after, and 3 months after participation in a group‐based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self‐efficacy (General Self‐Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t‐tests for normally distributed data and Wilcoxon signed‐rank test for skewed data. Results Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3‐month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period. Conclusion The complexity self‐management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected diabetes patients referred from primary care.