Type 2 diabetes mellitus and its complications is increasingly prevalent in Sri Lanka, imposing a serious health issue. This study assessed the effectiveness of one-to-one diabetes management education based on a patient education model for glycaemic control to establish if education intervention utilising the Health Education Impact Questionnaire resulted in knowledge improvement.
Aim: The aims of this study were; to examine the impact of a culturally appropriate, pharmacist delivered, health-education program on patient diagnosed with diabetes medication and condition self-management through an education intervention to improving their glycaemic control and delay disease complications; and to validate the Sinhalese translated heiQTM appropriateness in measuring the current health education level and the impact of the education intervention provided to Sri Lanka T2DM patients.
Design and methods: The study was designed as a prospective, non-experimental control group study. The repeated health-education interventions group was compared to the non- intervention group at baseline, followed up at six and 12 months. The intervention group was further randomised in to subgroups A and B to determine the effect of the repeated education. The improvements in knowledge using health education impact questionnaire(heiQTM) and glycaemic control by level of HbA1c as primary outcomes together with other biomarkers (systolic and diastolic pressure, lipid profile, body mass index (BMI), waist circumference, weight) determined using the questionnaire, laboratory testing and investigator measurements at baseline, at six and twelve months follow-up. Comparison of baseline values, changes and comparisons of groups and sub group level differences in follow up were analysed using t test, chi square, analysis of variance and covariance.
Results: Out of the total study sample (n=152 participants) there were more female participants (108,71%) than male (44, 30%) across the entire sample. There was a significant reduction (15.9%) in HbA1c level in the intervention group after participants received education on self-management. In subgroup B (with repeated education) 37.2% participants achieved HbA1c level of 6.5mmol/L or below, while only 27.7% in subgroup A (with single education intervention) achieved the same level. The intervention group compared to the non-intervention group had a statistically significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic pressure and BMI, while no significant differences were achieved in weight and waist circumference. The greatest effect size (≥ 0.8) was found in health directed behaviour, positive and active engagement in life and health service navigation, while a medium effect size (0.5-0.8)was recorded in constructive attitudes and approaches, skills and technique acquisition, social integration and support and emotional wellbeing with respect to the impact on health education in the intervention group compared to usual care group with no education intervention.
Discussion and Conclusion: It is imperative for pharmacists, as both health educator and provider, to deliver health-education programs that are tailored to the individuals’ needs and patient centred. Patients experienced a reduction in HbA1c level at 6 months and twelve months compared with the control group (usual care, no education intervention). The findings of this study demonstrated the suitability of a one-to-one structured education program for type 2 diabetes patients. Further, this study revealed that the Sinhalese translated version of the heiQTM questionnaire was sensitive and accurate in assessing knowledge improvement among the Sri Lankan participants with type 2 diabetes with the positive impact on all domains of the health education impact questionnaire assessed. All other biomarkers were improved in the intervention group compared with the non-intervention group.
|Date of Award||2017|
|Supervisor||Patrick Ball (Supervisor) & Hana Morrissey (Supervisor)|
Student thesis: Doctor of Philosophy (PhD) - CDU