PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmcphBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Public Health
 
BMC Public Health. 2012; 12: 652.
Published online Aug 14, 2012. doi:  10.1186/1471-2458-12-652
PMCID: PMC3490905
Supporting self-management after attending a structured education programme: a qualitative longitudinal investigation of type 1 diabetes patients’ experiences and views
David Rankin,corresponding author1 Debbie D Cooke,2 Jackie Elliott,3 Simon R Heller,3 and Julia Lawton1, the UK NIHR DAFNE Study Group
1Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK
2Epidemiology & Public Health, University College London, London, WC1E 6BT, UK
3Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, S10 2JF, UK
corresponding authorCorresponding author.
David Rankin: a.d.rankin/at/ed.ac.uk; Debbie D Cooke: debbie.cooke/at/ucl.ac.uk; Jackie Elliott: j.elliott/at/sheffield.ac.uk; Simon R Heller: s.heller/at/sheffield.ac.uk; Julia Lawton: J.Lawton/at/ed.ac.uk
Received March 12, 2012; Accepted August 3, 2012.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Articles from BMC Public Health are provided here courtesy of
BioMed Central