Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK.
BMC Public Health. 2012 Aug 14;12:652. doi: 10.1186/1471-2458-12-652.
Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates.
Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach.
While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one's diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an 'as and when needed' basis.
Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programme's practices and principles. This support should be tailored and personalised to reflect patients' specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research.
针对糖尿病和其他慢性病患者的结构化教育课程正被广泛采用。然而，后续研究表明，课程结业者可能难以随着时间的推移持续实施课程中教授的自我护理实践。本研究探讨了接受以赋权方法为基础并培训灵活强化胰岛素治疗的结构化教育课程后，1 型糖尿病患者的支持需求，该方案目前广泛用于治疗该疾病。本研究的目的是为课程结业者提供未来的支持。
在英国参加剂量调整正常进食课程（DAFNE）的 30 例 1 型糖尿病患者，在课程结束后、6 个月和 12 个月时进行重复深入访谈。使用归纳主题分析方法对数据进行分析。
尽管 DAFNE 课程中教授的灵活强化胰岛素治疗方法被认为是管理糖尿病的一种合理且有效的方法，但它也被认为比其他胰岛素方案更具技术复杂性。为了随着时间的推移持续有效地使用灵活强化胰岛素治疗来管理疾病，患者通常期望并需要接受接受过该方法培训的医疗保健专业人员提供持续的输入和支持。这包括帮助确定胰岛素剂量调整、提供保证以及解决问题的机会。虽然在小组环境中接受随访支持有一些好处，但大多数患者表示更喜欢或需要接受经过适当培训的临床医生提供的个性化支持，以按需获得支持。
我们的研究结果突出了群体随访支持在维持 1 型糖尿病自我管理方面的潜在局限性。为了使 1 型糖尿病患者从结构化教育中获得的临床获益能够持续，课程结业者可能会受益于并更倾向于接受接受过方案实践和原则培训的医疗保健专业人员提供的一对一支持。这种支持应根据患者在日常生活中应用教育和培训的具体和独特经验进行定制和个性化，这可能是未来研究的主题。
