Bruttomesso D, Costa S, Dal Pos M, Crazzolara D, Realdi G, Tiengo A, Baritussio A, Gagnayre R
Department of Clinical and Experimental Medicine, University of Padova, Italy.
Diabetes Metab. 2006 Jun;32(3):256-61. doi: 10.1016/s1262-3636(07)70277-x.
Diabetic patients should understand their disease correctly and be sure of what they know, but certainty is rarely considered by educators. Furthermore little is known about how certainty changes with time after an educational intervention. To clarify this, in 38 patients with type 1 diabetes (0.3-36 years duration) we analysed the effect of a course on insulin use by administering a questionnaire before the course, after the course and 1 and 3 years later.
Answers, accompanied by a subjective estimate of the degree of certainty, were assigned to mastered knowledge (certainty>or=90%, correctness>or=90%), hazardous knowledge (certainty>or=90%, correctness<or=50%), uncertain knowledge (certainty<or=50%, correctness>or=90%) and residual knowledge (total-[mastered+hazardous+uncertain]). Answers were then counted and changes in distribution among areas were analysed by the chi2 test. We also followed the fate of wrong answers.
The course increased mastered knowledge, while other types of knowledge decreased. With time mastered knowledge decreased, patients losing both correctness and certainty. The loss affected declarative knowledge, based purely on theory, more than procedural knowledge, which concerns the way things are done. Wrong answers, mostly given with high degree of certainty, were heterogeneous since some became correct after the course, some remained wrong, some became wrong after the course, some became mistaken after having been corrected earlier.
The analysis of certainty helps in evaluating patient's knowledge; programmes tending to improve procedural knowledge are more likely to have long lasting effects; wrong answers need to be considered on a individual basis.
糖尿病患者应正确理解自身疾病并明确自己所掌握的知识，但教育工作者很少考虑确定性这一因素。此外，对于教育干预后确定性如何随时间变化知之甚少。为了阐明这一点，我们对38例1型糖尿病患者（病程0.3 - 36年）进行了分析，通过在课程开始前、课程结束后、1年后和3年后发放问卷，了解一门关于胰岛素使用课程的效果。
答案需附带对确定性程度的主观估计，分为已掌握知识（确定性≥90%，正确率≥90%）、有害知识（确定性≥90%，正确率≤50%）、不确定知识（确定性≤50%，正确率≥90%）和剩余知识（总数 - [已掌握 + 有害 + 不确定]）。然后对答案进行计数，并通过卡方检验分析各领域分布的变化。我们还追踪了错误答案的后续情况。
该课程增加了已掌握知识，而其他类型的知识减少。随着时间推移，已掌握知识减少，患者在正确性和确定性方面均有所丧失。这种丧失对纯粹基于理论的陈述性知识的影响大于对涉及做事方式的程序性知识的影响。错误答案大多是在高度确定的情况下给出的，具有异质性，因为有些在课程结束后变得正确，有些仍然错误，有些在课程结束后变得错误，有些在之前被纠正后又出现错误。
对确定性的分析有助于评估患者的知识；倾向于提高程序性知识的项目更有可能产生持久影响；错误答案需要根据个体情况进行考虑。
