Lifeng Fan

Effectiveness of Diabetes Self-management Education Intervention Elements: A Meta-analysis

ABSTRACT OBJECTIVES This meta-analysis aimed to examine differences in knowledge, self-management behaviours and metabolic control associated with various diabetes self-management education (DSME) intervention elements. METHODS Fifty randomized, controlled trials evaluating DSME interventions in adults with type 2 diabetes, published in English between 1990 and 2006, were included in the analysis. Data related to type of intervention, teaching method, mode of delivery and dose were extracted. RESULTS Overall, the weighted mean effect size of the DSME interventions was 1.29 for knowledge, 0.51 for metabolic control and 0.36 for self-management behaviours. Differences in outcomes were observed for number of sessions, duration of intervention and provision of booster sessions. CONCLUSIONS These results provide researchers and practitioners with evidence to guide the design of DSME interventions that are effective in improving knowledge, behaviour and metabolic control outcomes among patients with type 2 diabetes.

Improving Foot Self-Care Knowledge, Self-Efficacy, and Behaviors in Patients With type 2 Diabetes at Low Risk for Foot Ulceration: A Pilot Study

The pilot study aimed to explore the effects of an educational intervention on patients’ foot self-care knowledge, self-efficacy, and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The intervention consisted of three sessions and was given over a 3-week period. A total of 70 eligible consenting participants were recruited for this pilot study. Fifty-six participants completed the study. The outcomes were assessed at pretest, following the first two sessions, and 3-month follow-up. The findings indicated that the foot self-care educational intervention was effective in improving foot self-care knowledge, self-efficacy and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with type 2 diabetes at low risk for foot ulcerations.

Feasibility, Acceptability and Effects of a Foot Self-Care Educational Intervention on Minor Foot Problems in Adult Patients with Diabetes at Low Risk for Foot Ulceration: A Pilot Study

OBJECTIVES The objectives of the pilot study were to examine the feasibility and acceptability of the foot self-care educational intervention, and to explore its preliminary effects on reducing the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. METHODS A one-group-repeated-measures design was used. The intervention given over 3 weeks consisted of a 1 hour 1-on-1 provider-patient interaction to discuss foot self-care strategies, 1 hour hands-on practice of strategies and 2 10-minute telephone contact booster sessions. Of the 70 eligible consenting participants, 56 completed the study. The outcomes were assessed at pretest and at 3-month follow-up. Chi-square and Fishers exact test were used to examine changes in outcomes over time. RESULTS The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes mellitus. It was effective in reducing the occurrence of minor foot skin and toenails problems (all p<0.05) at 3-month follow up. CONCLUSIONS The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Implementing the Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions: An Illustration

Background Persons’ cultural beliefs about a health problem can affect their perceived acceptability of evidence-based interventions, undermining evidence-based interventions’ adherence, and uptake to manage the problem. Cultural adaptation has the potential to enhance the acceptability, uptake, and adherence to evidence-based interventions. Purpose To illustrate the implementation of the first two phases of the integrated strategy for cultural adaptation by examining Chinese Canadians’ perceptions of chronic insomnia and evidence-based behavioral therapies for insomnia. Methods Chinese Canadians (n = 14) with chronic insomnia attended a group session during which they completed established instruments measuring beliefs about sleep and insomnia, and their perceptions of factors that contribute to chronic insomnia. Participants rated the acceptability of evidence-based behavioral therapies and discussed their cultural perspectives regarding chronic insomnia and its treatment. Results Participants actively engaged in the activities planned for the first two phases of the integrated strategy and identified the most significant factor contributing to chronic insomnia and the evidence-based intervention most acceptable for their cultural group. Conclusions The protocol for implementing the two phases of the integrated strategy for cultural adaptation of evidence-based interventions was feasible, acceptable, and useful in identifying culturally relevant evidence-based interventions.

Effects of an intensive foot self-care education in the prevention of foot problems in adult patients with diabetes

| 275 age was 61.6±11.9 years old, average duration of diabetes was 7.9±6.2 years. The patients in the usual educational group received the routine diabetic treatment and general diabetes education (4-5 hrs). The patients in the experimental group received individual intensive education on foot self-care(6-7.5 hrs), given by the diabetes nurse educator in the outpatient department on repeated occasions, in addition to usual diabetes education (4-5 hrs). In terms of participants’ baseline data on demographic characteristics (i.e., age, sex, education, employment) and diabetes characteristics (i.e., type of diabetes, duration of diabetes, presence of complications, the type of treatment), there were no significant differences between the experimental group and the comparison group (all P > 0.05). The two groups were comparable on all baseline data. The effects were evaluated before education and nine months after education. results: The results indicated improvement in patients’ recognition of signs of foot problems. Increased knowledge and skills of daily foot self-care strategies, selecting suitable shoes and socks, and cutting toenails were significantly improved in the experimental group after education(P<0.05). Foot problems such as dry and cracked skin, callus, fungal infection, and foot lesions were reduced significantly nine months after education in the experimental group(P<0.05-P<0.001). FBG, 2hrs PBG, HbA1c, BMI and blood pressure were controlled much better in the experimental group, compared with the comparison group, and the differences were significant (P<0.05). conclusions: The intensive foot self-care educational intervention was effective in enhancing patients’ foot self-care skills and in preventing foot problems. This intervention should be incorporated as an additional component in intensive and comprehensive educational programs to assist patients’ diabetes self-management. Diabetes education delivery No conflict of interest