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The Knowledge Acquired from the Diabetes Education Clinic Class at the Pembroke Regional Hospital

The Knowledge Acquired from the Diabetes Education Clinic Class at the Pembroke Regional Hospital. Dietetic Intern: Qiuhong Han (Catherine) Advisor: Mary Ann Carroll, RD CDE. Acknowledgements. Many thanks to all mentors and advisors Pembroke Regional Hospital:

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The Knowledge Acquired from the Diabetes Education Clinic Class at the Pembroke Regional Hospital

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  1. The Knowledge Acquired from the Diabetes Education Clinic Class at the Pembroke Regional Hospital Dietetic Intern: Qiuhong Han (Catherine) Advisor: Mary Ann Carroll, RD CDE

  2. Acknowledgements Many thanks to all mentors and advisors • Pembroke Regional Hospital: Mary Ann Carroll, RD CDE, Judy Hill, RD CDE, Manager of Clinical Nutrition and Diabetes Education, Becky Campbell, Dietitian’s Assistant • The Ottawa Hospital Dietetic Internship Program: Barbara Khouzam, RD, MPA, Josee Bertrand, RD, Coordinator of the Dietetic Internship, Renée Crompton, RD, Louise Gariepy, Statistician, Lynne Lewis, Clerk of the internship,

  3. Overview • Introduction • Procedures and Methods • Results and Discussion • Conclusion

  4. Diabetes • Chronic degenerative illness with great negative effects on health • Prevalence in Canada > 2 million people1 • Cost of diabetes and its complications ~ $13.2 million / year2

  5. Diabetes Education • Most complications are preventable by correct self-management3 • Significant knowledge deficit among those with diabetes3 • Diabetes education was introduced in the 1930’s. • Diabetes education enhances positive lifestyle changes • Diabetes education programs are clinically worthwhile and cost-effective4

  6. DEC at the PRH • PRH one of five sites of Renfrew County Diabetes Education Program • DEC is multidisciplinary: RDs, RNs, Dietitian’s Assistant • ~1 hour group class • Individual appointment with RD and RN DEC= Diabetes Education Clinic PRH=Pembroke Regional Hospital RD= Registered Dietitian RN= Registered Nurse

  7. Study Objective and Goal • Determine the knowledge acquired by clients who attend the DEC group class • Appropriately revise the presentation or material presented in the DEC group class

  8. Inclusion Criteria • > 18 years old • Pre-diabetes, type 1 or type 2 diabetes • Signed consent • Attended DEC group class between February 28th, 2008 and March 13th, 2008 • Completed pre-class, post-class and one-week-follow-up tests • 20 qualified participants

  9. The Questionnaire • Identical for all three tests • Based on DEC group class • Validated by 5 RDs and 2 RNs (Diabetes Educators) • Two parts: demographic section and knowledge section

  10. Procedure • Pre-class test immediately before attending class • Post-class test immediately after class • One-week-follow-up test: investigator by telephone

  11. Data Analysis • SPSS 16.0 Graduate Student Version • Whether clients’ diabetes-related knowledge improved after attending class • Whether knowledge improvement associated with demographic characteristics • Pre-existing knowledge gaps

  12. Results –knowledge improvementpaired samples t-test plus Bonferroni Correction (p<0.017)

  13. Discussion • Diabetes-related knowledge improved • Retained knowledge for one week • Consistent with results from other similar studies5-9

  14. Results –Demographics • Independent sample t-test plus Bonferroni Correction (p<0.017) • Pre-class test: p<0.017 Males: 7.79 + 2.359 Females: 4.17 + 2.137 • One-week-follow-up test: p<0.017 Males: 10.00 + 1.414 Females: 7.83 + 1.472 No statistically significant difference between males and females on post-class test

  15. Results - Demographics • No significant differences associated with • age • type of diabetes • duration of diabetes • previously attended a diabetes class • having seen an RD / RN for diabetes • level of schooling • Previous studies: knowledge improvement not related to demographic characteristics10

  16. Discussion - demographics Continue…

  17. 12 clients used more than one method to manage their diabetes

  18. Results –Knowledge Gaps

  19. DiscussionQuestion 4. A1C target 4. Your A1C should be: a. less than 5 b. less than 6 c. less than 7 d.I don’t know

  20. DiscussionQuestion 4. A1C target 3 clients (15%) correct on pre-class test 4 clients (20%) correct on post-class test Improvement: 1 clients (5%) Rothman et al: 8% of 217 participants knew the normal A1C range11 Setter et al: A1C value poorly understood12

  21. DiscussionQuestion 7. TC/HDL cholesterol ratio 7. Your cholesterol ratio (TC/HDL) should be less than: a. 2.0 b. 4.0 c. 6.0 d. I don’t know

  22. DiscussionQuestion 7. TC/HDL cholesterol ratio 3 clients (15%) correct on pre-class test 11 clients (55%) correct on post-class test Improvement: 8 clients (40%) Cheng et al: • cholesterol knowledge poor among population • cholesterol education needed to improve knowledge13

  23. Discussion Question 9. one aspect of healthy eating 9. Which of the following is part of healthy eating? a. having 2-3 servings of vegetables and fruits each day b. eating 2 meals each day, when hungry c. having whole grains most of the time d. I don’t know

  24. Discussion Question 9. one aspect of healthy eating 2 clients (10%) correctly on pre-class test 3 clients (15%) correct on post-class test Improvement: 1 client (5%) Falk et al: almost all of the 79 participants classified vegetable and fruit as healthy food14

  25. Study Limitations • Small sample size • Follow-up time line • Larger sample size and a longer follow-up period needed to confirm findings

  26. Conclusion • Improved diabetes knowledge • knowledge retained for one week • Consider revising class presentation regarding A1C and healthy eating concept

  27. References 1. Canadian Diabetes Association. The prevalence and costs of diabetes. http://www.diabetes.ca/Section_About/prevalence.asp 2. American Diabetes Association 2000, statistics Canada 2000 3. Clement S. Diabetes self-management education. Diabetes Care 1995; 18: 1204-1214. 4. Ridgeway NA. Harvill DR. Harvill LM. et al. Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. Southern Medical Journal 1999: 92(7):667-672. 5. Ridgeway NA. Harvill DR. Harvill LM. et al. Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic. Southern Medical Journal 1999: 92(7):667-672. 6. Leonard J. Outcomes of a Diabetes Education Program. Public Health Reports 1984: 99 (6): 575-579. 7. Miller C K. Evaluation of a food label nutrition intervention for women with type 2 diabetes mellitus. Journal of the American Dietetic Association 1999: 99: 323-328. 8. Chapman-Novakofski K. Karduck J. Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a community-based diabetes education program. Journal of the American Dietetic Association 2005:105(10):1613 1616.

  28. References(continued) 9. Garrett N. Hageman CM. Sibley SD. et al. The effectiveness of an interactive small group diabetes intervention in improving knowledge, feeling of control, and behavior. Health Promotion Practice 2005: 6(3):320-328. 10. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood- glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–853. 11. Rothman RL. Malone R. Bryant B. et al. The Spoken Knowledge in Low Literacy in Diabetes scale: a diabetes knowledge scale for vulnerable patients. Diabetes Educator 2005: 31(2):215-224. 12. Setter SM. Corbett CF. Campbell RK. et al. A survey of the perceptions, knowledge, and use of A1C values by home care patients and nurses. Diabetes Educator 2003: 29(1):144-152. 13. Cheng S. Lichtman JH. Amatruda JM. et. Knowledge of cholesterol levels and targets in patients with coronary artery disease. Preventive Cardiology 2005: 8(1):11-17. 14. Falk LW. Sobal J. Bisogni CA. Connors M. et al. Managing healthy eating: definitions, classifications, and strategies. Health Education & Behavior 2001:28(4):425-439.

  29. Thank You Comments and Questions

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