The objective of this study was to evaluate the short-term impact of a 7-h type 2 diabetes continuing medical education (CME) program. Ten PHC were distributed randomly into two groups: five PHC in the intervention group and five PHC in the control group. The EuroQoL-five-dimensional (EQ-5D) scale was used to assess HRQoL. The results are presented descriptively. The scores identify the attitude regarding five key areas of diabetes, namely need for special training, seriousness of diabetes, value of tight control, psychosocial impact and patient autonomy. ISSN 1680-5348. A descriptive correlational cross-sectional survey of 178 adults recruited from urban residential areas of the San Francisco Bay Area was conducted.
India takes one rank better when FM distress is measured on the DAWN Impact of Diabetes Profile Family Member scale: India scores 54.5 (51.8-57.2) against a global mean of 51.8. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Nurses and midwives provide information and advice to women with gestational diabetes. For analysis, data were transferred to SAS 9.0 software. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. These findings mimic much of the research on knowledge retention following CME. For them the assessment of emotional burden is a necessity to make emotional support in diabetes patients, and to improve their quality of life through empowerment strategies .
A significant number of analyses were conducted, raising issues of multiple hypotheses testing, which might have been avoided through adjustment of the significance level used. However, given the exploratory nature of the work, we wanted to avoid missing any potentially important relationships early into the development process. All participants were recruited from three general practices and within an inner-city area of North West of England. Sampling was restricted to responders who opted-in to the interview study and on completion of a postal survey. Nurses and midwives provide information and advice to women with gestational diabetes. Ethical requirements meant that respondents had to opt-in to both studies, and such participants may demonstrate certain characteristics, whereas a more diverse sample may have given different results. The potential for bias may be especially high in terms of the limited range of deprivation in the sample, as patients from less deprived backgrounds may have markedly different views.
Hence, even though patients themselves are primarily responsible for managing their illness, it seems important that partners are structurally involved in diabetes care. An innovative approach and a real paradigm shift is required to recognize that patients are in control of and responsible for the daily self-management of diabetes . It was not possible to explore characteristics of non-respondents as current ethical guidelines do not allow data recording on patients who do not consent to participate. As outlined previously, the existence of five distinct dimensions of empowerment suggested by the qualitative work were not supported by the quantitative findings in study 2. The factor analyses suggested that responses to items concerning ‘identity’ and ‘control’ were related, as were issues of ‘knowledge and understanding’ and ‘decision making’, and these relationships make conceptual sense. The meaning of the third factor was very unclear, but the fact that items related to ‘enabling others’ only loaded on this factor might suggest that further tests using only these items would be useful, to see if the validity of this factor was supported. The factor was derived from the patient interviews, and is interesting as it relates to current self-management initiatives in the NHS, such as the Expert Patients Programme , and the Health Trainers initiative , which both rely on non-professionals to teach and empower patients who may be coping less well with their long-term conditions .
We would suggest that further psychometric work on this scale is indicated as it has potential wider utility. The scale’s banner was put on top of every page of the questionnaire, guiding the respondents to refer consistently, the right scale. In terms of construct validity, the majority of hypotheses were supported from the regression results. Seeing a preferred GP, being educationally qualified and general health were strong predictors of increases in total empowerment. Hypotheses that were not confirmed included the importance of continuity of care and GP confidence and total empowerment. It is noteworthy that seeing a preferred GP emerged as a key predictor in the analysis, but continuity with the doctor and GP confidence were found to be weak predictors of empowerment. It should be noted that nearly half (49.8%) of responders had not seen their GP/practice nurse for at least 7 to 9 months, which may have introduced a bias in responses on empowerment items that related to GP variables.
Fear of hypoglycemia is important to discuss with patients to educate them that hypoglycemic episodes can often be avoided through adjustment of insulin and careful vigilance in self-monitoring of blood glucose. It is possible that other measures of continuity may have given different results. For instance, twelve continuity measures have been developed to measure various types of continuity , each emphasizing different elements of the patient-practitioner relationship, such as density of visits and subjective perception of visit . It may also reflect the fact that nurses provide the bulk of long-term condition care in the United Kingdom. Future testing of the measure may also benefit from confirmatory factor analysis to more rigorously test hypotheses about scale structure, given that ambiguities remain concerning the validity of the three factor solution and the concern over scale length. We are aware routine use of the new measure is likely to be enhanced by reducing the number of items. Following future large-scale validation of the measure, a short-form version should be developed and tested to lower response burden and increase the possibility of routine use of the measure.
The development and testing of the short-version should follow state of the art methodology for shortening composite measurement scales . A high PTMEA Corr means that an item is able to distinguish between the ability of respondents. Interventions that might be expected to lead to increased empowerment might include: GP communication skills training ; patient decision aid interventions ; and self-management support, such as the chronic disease self-management programme . Future research might also explore the relationship between measures of illness perceptions, such as the Illness Perception Questionnaire , which is designed to capture representations of specific illnesses, rather than generic feelings of empowerment. Exploring relationships between the measures may be fruitful, as it is possible that certain types of illness representations (such as those around controllability) may be predictive of levels of empowerment. The new measure has similarities with the Patient Activation Measure  and a formal comparison might highlight advantages and disadvantages of each. Both measures have different psychometric properties and underlying scale structure.
The Patient Activation Measure  has stronger psychometric properties than the current measure and was developed from the Rasch Rating Scale Model , an alternative statistical method to factor analysis, used to test scale structure. As a result, the elements of knowledge, belief, and skill that constitute activation have a hierarchical order; thus what is needed to increase activation depends on where the person is on the activation continuum. There are many other factors not measured in the current study that could be used to assess construct validity. For instance, a quality of life measure or other measures of psychological functioning may have been useful. It was also evident from the qualitative data (not presented here), that health literacy was a key issue in this group of patients, and this could have been examined by administering a health literacy measure . However, such scales can be difficult to use in the context of a postal survey.