‘Educator talk’ and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial

Skinner, Timothy; Carey, Marian; Cradock, Sue; Dallosso, Helen; Daly, Heather; Davies, Melanie J.; Doherty, Yvonne; Heller, Simon; Khunti, Kamlesh; Oliver, Lindsay

doi:10.1111/j.1464-5491.2008.02492.x

Cited by 53 publications

(52 citation statements)

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“…The program is 180 min long; 105 min are dedicated to addressing the causes, complications, timeline, and identity of IGT and 75 min are targeted to addressing the perceived effectiveness of exercise as a treatment for IGT, walking self-efficacy beliefs, barriers to walking, and self-regulatory strategies. The program has a written curriculum, modeled on the person-centered philosophy and learning techniques developed for the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) program (9–11), an established nationally available 6-h structured educational program designed to promote lifestyle change and self-management for those with newly diagnosed type 2 diabetes in the U.K.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance

et al. 2009

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OBJECTIVETo investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance (IGT).RESEARCH DESIGN AND METHODSOverweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester, U.K. Participants were randomly assigned to one of three groups. Group 1 received a 3-h group-based structured education program designed to promote walking activity using personalized steps-per-day goals and pedometers. Group 2 received a 3-h group-based structured education program designed to promote walking activity using generic time-based goals. Group 3 received a brief information leaflet (control condition). Outcomes included an oral glucose tolerance test, standard anthropometric measures, ambulatory activity, and psychological variables. Follow-up was conducted at 3, 6, and 12 months.RESULTSA total of 87 individuals (66% male, mean age 65 years) were included in this study. At 12 months, significant decreases in 2-h postchallenge glucose and fasting glucose of −1.31 mmol/l (95% CI −2.20 to −0.43) and −0.32 mmol/l (−0.59 to −0.03), respectively, were seen in the pedometer group compared with the control group. No significant improvements in glucose control were seen in those given the standard education program.CONCLUSIONSThis study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT. This result is likely to have important implications for future primary care–based diabetes prevention initiatives.

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Section: Methodsmentioning

confidence: 99%

Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance

et al. 2009

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“…Also, providing more information was not always regarded as being a better approach. Skinner et al (2008) for example reported that the more the patients' knowledge of their illness increased the less the educators talked. Dibbelt et al (2010) described that although physicians showed good capabilities to establish emotional relationships during their study they still lacked the ability to effectively inform and motivate their patients.…”

Section: Information Provisionmentioning

confidence: 99%

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

Riedl

Schüßler

2017

Zeitschrift für Psychosomatische Medizin und Psychotherapie

127

111

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Zusammenfassung Der Einfluss dertion gathering, or patient education). We conducted a systematic review including publications from 2000 to 2015 to gather further empirical support. Methods: A systematic review was carried out (with information drawn mainly from Medline, Embase, Cochrane, PsychLit, and Psyndex) to identify RCTs as well as controlled and uncontrolled studies in clinical adult samples. Studies with psychiatric samples and psychologicalpsychotherapeutic interventions were excluded. Results: A total of 17 RCTs, 17 controlled studies, and 8 qualitative studies met the inclusion criteria. The quality of the RCTs and controlled studies was satisfying. In the doctor-patient relationship (building), 60% of the studies showed a positive effect on objective health parameters. Information gathering and provision (patient education) were the most investigated domains with unequivocally positive effects. Communication (skills) showed improved results and enabled treatment-related emotions and behavior. Two studies included an economical evaluation with reduced healthcare costs. Conclusions: A systematic review revealed different domains of the doctor-patient relationship and communication with convincing effects regarding different objective and subjective health outcomes.

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“…The 10-second event coding is an objective measure and an established method of measuring talk time-to-educator ratio. 258,259 DOI: 10.3310/pgfar05110 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL. 5 NO.…”

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confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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‘Educator talk’ and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial

Cited by 53 publications

References 14 publications

Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance

Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

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