Elsevier

Public Health

Volume 139, October 2016, Pages 170-177
Public Health

Original Research
Self-rated health as a predictor of outcomes of type 2 diabetes patient education programmes in Denmark

https://doi.org/10.1016/j.puhe.2016.06.018Get rights and content

Highlights

  • Long-term effect of patient education was measured using HeiQ.

  • Diabetes patients with optimal self-rated health benefit from patient education.

  • No improvements in outcome among patients with poor self-rated health.

  • Patient education may not be equally suitable for all diabetes participants.

Abstract

Objective

To explore if self-rated health (SRH) can predict differences in outcomes of patient education programmes among patients with type 2 diabetes over time.

Study design

This is an observational cohort study conducted among 83 patients with type 2 diabetes participating in patient education programmes in the Capital Region of Denmark.

Methods

Questionnaire data were collected by telephone interview at baseline and 2 weeks (77 participants, 93%) and 12 months (66, 80%) after the patient education ended. The seven-scale Health Education Impact Questionnaire (HeiQ) was the primary outcome. The independent variable was SRH, which was dichotomized into optimal or poor SRH. Changes over time were assessed using mean values and standard deviation (SD) at each time point and Cohen effect sizes. Odds ratios and 95% confidence intervals were calculated for the likelihood of having poor SRH for each baseline sociodemographic and health-related variable.

Results

Twelve months after patient education programmes, 60 (72%) patients with optimal SRH at baseline demonstrated increased self-management skills, overall acceptance of chronic illness, positive social interaction with others, and improved emotional well-being. Participants with poor SRH (23, 28%) reported no improvements over time. Not being married (odds ratio [OR] 7.79, P < 0.001), living alone (OR 4.93, P = 0.003), having hypertension (OR 8.00, P = 0.031), and being severely obese (OR 4.07, P = 0.009) were significantly associated with having poor SRH. After adjusting for sex, age and vocational training, marital status (OR 9.35, P < 0.001), cohabitation status (OR = 4.96, P = 0.005) and hypertension (OR 10.9, P = 0.03) remained associated with poor SRH.

Conclusions

We found a strong association between SRH and outcomes of patient education, as measured by the HeiQ, at 12 months. Only participants with optimal SRH appeared to benefit from patient education. Other patient characteristics may be responsible to explain the observed difference between patients with optimal and poor SRH.

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)

  • International Diabetes Federation

    Diabetes atlas

    (2013)
  • R.W. Thomsen et al.

    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

    (2012)
  • A. Green et al.

    Incidence, morbidity, mortality, and prevalence of diabetes in Denmark, 2000–2011: results from the Diabetes Impact Study 2013

    Clin Epidemiol

    (2015)
  • T. Bodenheimer et al.

    Patient self-management of chronic disease in primary care

    JAMA

    (2002)
  • I. Willaing et al.

    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]

    (2005)
  • J. Chodosh et al.

    Meta-analysis: chronic disease self-management programs for older adults

    Ann Intern Med

    (2005)
  • A. Warsi et al.

    Arthritis self-management education programs: a meta-analysis of the effect on pain and disability

    Arthritis Rheum

    (2003)
  • L. Venskutonyte et al.

    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

    (2013)
  • A.J. Hayes et al.

    Can self-rated health scores be used for risk prediction in patients with type 2 diabetes?

    Diabetes Care

    (2008)
  • C.A.M. Paddison et al.

    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

    (2008)
  • Capital Region of Denmark

    Sygdomsspecifik patientuddannelse for type 2 diabetes [Disease specific patient education for type 2 diabetes]

    (2011)
  • G.M. Sullivan et al.

    Using effect size – or why the P value is not enough

    J Grad Med Educ [Internet]

    (2012)
  • L. Cronbach

    Coefficient alpha and the internal structure of tests

    Psychom Springer-Verlag

    (1951)
  • Cited by (4)

    • Identifying subgroups based on self-management skills in primary care patients with moderate medically unexplained physical symptoms

      2019, Journal of Psychosomatic Research
      Citation Excerpt :

      In MUPS, the partnership with health care services depends on a great number of factors (e.g. on the quality of the patient doctor relationship, which in MUPS is complicated [1]) and only partially on personal self-management skills. Therefore, as in previous research, only individual empowerment was assessed [33] and consequently only constructs one to seven were included as cluster variables. In cluster analysis there is no generally accepted rule for sample size calculation [34].

    • Self-rated health and oral health in type 2 diabetic patients - A case-control study

      2018, Revista Portuguesa de Estomatologia, Medicina Dentaria e Cirurgia Maxilofacial
    View full text