Original ResearchSelf-rated health as a predictor of outcomes of type 2 diabetes patient education programmes in Denmark
Introduction
During the last 20 years, the prevalence of type 2 diabetes (T2D) has increased dramatically in many parts of the world, and the disease is now a worldwide public health problem. In 2013, 382 million people worldwide were diagnosed with diabetes, a global prevalence of 9%.1 This number continues to increase and is estimated to reach more than 500 million people in 2030.2, 3, 4 The prevalence of diabetes in Denmark is currently 6% of the adult population but is increasing rapidly.5, 6 The growing population of patients with diabetes has required a change in care. Treatment of diabetes is an around-the-clock activity, and more than 95% of the daily management of diabetes is conducted by patients.7 Patient education programmes have been developed for patients with diabetes to help them acquire the knowledge and skills to better manage their disease in their everyday lives. Patient education plays a central role in supporting and creating individual changes to achieve good quality of life and health despite illness.8
Since the 1990s, the Danish healthcare system has offered a number of disease-specific patient education programmes to people with chronic conditions.9 However, some challenges are associated with patient education programmes. Several studies suggest that patient education programmes might not be suitable for all types of chronic conditions and population subgroups.10, 11, 12 More research is needed to explore diabetes-specific patient education and involved participants.
Self-rated health (SRH) is a useful and convenient tool for identifying individuals at increased risk of unfavourable health outcomes; e.g. cardiovascular events for patients with diabetes.13 It is regarded as a valuable risk predictor of complications among patients with diabetes.14 SRH can also be an outcome measure15 and a goal for effective self-management.16 SRH can thus serve as a comprehensive screening tool for patients' health status. However, positive SRH is no guarantee of good physical health, and poor SRH warrants further attention.15 In this study, we explore whether SRH at baseline predicts differences over time in the outcomes of diabetes patient education programmes using the Health Education Impact Questionnaire (HeiQ) in the Capital Region of Denmark.
Section snippets
Study design
An observational cohort study was conducted among patients with T2D participating in patient education in the Capital Region of Denmark. Data were collected by telephone questionnaire three times: 2 weeks before patient education started (baseline, T1) and 2 weeks (T2) and 12 months (T3) after it ended.
Patient education programmes
Hospitals and municipalities in the Capital Region of Denmark offer standardized group-based patient education to patients with T2D at either municipalities or in hospitals.17 The programme
Participants
Of the 83 participants completing the baseline questionnaire (Fig. 1), 76 (93%) provided follow-up data at 2 weeks (T2) and 66 (80%) provided follow-up data at 12 months (T3). Compared to participants completing all three interviews, participants who dropped out between T1 and T2 and between T1 and T3 were either younger than 65 years or older than 75 years (P = 0.03 and P = 0.01, respectively). Between T1 to T3, participants who dropped out were more likely to be employed (P = 0.04) and have
Discussion
We investigated whether SRH could be used as a predictor of differences in outcomes of T2D patient education, finding that only participants with optimal SRH at baseline experienced improvements from patient education over both the short and long term. Among participants with optimal SRH, we observed a large effect size after 12 months in the construct of skills and technique acquisition, which is related to management of blood glucose monitoring among other relevant skills.18 Small effect
Acknowledgements
The authors wish to thank Professor Richard H. Osborne, Deakin University, for the use of the HeiQ questionnaire for the purpose of this study. The authors also thank Jennifer Green for skillful editing.
Ethical approval
The study was approved by the Danish Data Protection Agency (number: BBH-2011-08 Diabetes patientuddannelse). Under Danish law, permission from an ethics committee was not required because biological material was not used in the study.
Funding
This study was part of a larger Ph.D. project and funded by
References (46)
- et al.
Global estimates of the prevalence of diabetes for 2010 and 2030
Diabetes Res Clin Pract
(2010) - et al.
IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030
Diabetes Res Clin Pract
(2011) Factors influencing the attitudes held by women with type II diabetes: a qualitative study
Patient Educ Couns
(1996)- et al.
Self-management interventions for chronic illness
Lancet
(2004) What is self-rated health and why does it predict mortality? Towards a unified conceptual model
Soc Sci Med
(2009)- et al.
The Health Education Impact Questionnaire (HeiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions
Patient Educ Couns
(2007) - et al.
The Danish SF-36 Health Survey: translation and preliminary validity studies
J Clin Epidemiol
(1998) - et al.
Multiple healthy behaviors and optimal self-rated health: findings from the 2007 behavioral risk factor surveillance system survey
Prev Med Balt
(2010) - et al.
Neuroticism and self-reported health in an elderly community sample
Pers Individ Dif
(1993) Global status report on noncommunicable diseases
(2014)
Diabetes atlas
The Danish Centre for Strategic Research in type 2 diabetes (DD2): organization of diabetes care in Denmark and supplementary data sources for data collection among DD2 study participants
Clin Epidemiol
Incidence, morbidity, mortality, and prevalence of diabetes in Denmark, 2000–2011: results from the Diabetes Impact Study 2013
Clin Epidemiol
Patient self-management of chronic disease in primary care
JAMA
Patientskoler og gruppebaseret undervisning – en litteraturgennemgang med fokus på metoder og effekter [Patient schools and group based education – a literature review focusing on methods and effects]
Meta-analysis: chronic disease self-management programs for older adults
Ann Intern Med
Arthritis self-management education programs: a meta-analysis of the effect on pain and disability
Arthritis Rheum
Self-rated health predicts outcome in patients with type 2 diabetes and myocardial infarction: a DIGAMI 2 quality of life sub-study
Diabetes Vasc Dis Res
Can self-rated health scores be used for risk prediction in patients with type 2 diabetes?
Diabetes Care
Psychological factors account for variation in metabolic control and perceived quality of life among people with type 2 diabetes in New Zealand
Int J Behav Med
Sygdomsspecifik patientuddannelse for type 2 diabetes [Disease specific patient education for type 2 diabetes]
Using effect size – or why the P value is not enough
J Grad Med Educ [Internet]
Coefficient alpha and the internal structure of tests
Psychom Springer-Verlag
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