Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-31

empowerment philosophy, enabling patient-directed focus of care using an interactive, collaborative approach to learning (85,89-93). The “Map Experience” has taught us that patients like to be active participants in their learning and they need to have the support to practice the skills they have been taught (44). This tool allows for self-expression and application of the knowledge, encouraging action toward behaviour change (85,94). The disadvantages that have been highlighted with the group approach include: inability to address personal concerns, inability to measure progress, limited access to care and, on the part of the educator, difficulty with group facilitation (87,89). Where individual contact has been compared to group interaction, some studies have shown a greater reduction in A1C with individual care (60,67). However, results continue to be mixed regarding other metabolic markers and behavioural outcomes. This evidence suggests that there is no clear indication as to the superiority of group over individual or visa versa. What has proven to be important in several studies is the contact time between the patient and the educator (60,77). One meta-analysis calculated that every hour of contact between the patient and the educator reduced the patient’s A1C by 0.04% (this postulates that 23.6 hours of contact with the educator could reduce the patient’s A1C by 1% (63,95,96). It has allowed far greater access to education and, in some cases, more personalized care (97,98). The majority of these education programs/services deal with the topics of BG monitoring, exercising, healthy eating, medication and/or problem solving. Several reviews have found that technological interventions have helped patients achieve lower A1C results, improved self-management behaviours and resulted in an increase in self efficacy (97-99). Studies have shown that the use of the mobile phone with the ability to deliver real time information, i.e. BG results via numbers and graphs, has resulted in a greater degree of engagement and an increase in patient satisfaction versus use of email (100-105). Some programs have been successful at using text messaging to attract at-risk populations and to reach teenagers to participate in programs, resulting in significant decrease in A1C, as opposed to usual care (106). Web-based learning programs with interactive components have proven to be as effective, if not more so, than traditional education programs (105). However, the caveat repeated throughout the majority of studies looking at technology and SME reveals that the most successful programs have a mixed delivery, with the technological intervention Technology Whether it is the cell phone, the internet, telehealth, virtual rooms or social media sites, technology has had a dramatic effect on the delivery of SME.