Research shows the risk for cognitive impairment and the rate of cognitive decline double after type 2 diabetes mellitus is diagnosed and can make self-management more difficult. Cognitive training has been found to be one way to improve self-management and cognitive function, and this article reports the adaptation of one such intervention to an online format. Ten adults with diabetes participated in an 8-week intervention that combined webinar classes with online computer game training. Perceived memory ability, executive function, self-management, and self-efficacy were measured. Evaluation of recruitment, data collection, and implementation demonstrated good feasibility and reduced barriers to engagement. Although the intervention did not result in significant changes in cognitive function, scores on all surveys improved. Adherence to diet, exercise, and foot care recommendations also improved. Most participants stated they preferred the intervention's online format to “traditional” in-person formats. Online technology in this 8-week intervention helped improve recruitment, retention, participant engagement, and use of cognitive strategies in people with type 2 diabetes mellitus. Overall, participants found the intervention helpful and said it reduced the time and travel burden associated with educational interventions. A larger randomized controlled trial is needed to further explore the intervention's potential impact over a longer period.
BackgroundComprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done.PurposeThe purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory.MethodsNineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios.ResultsTalk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable.Implications for PracticeTalk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.
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