Building Competency in Diabetes Education THE ESSENTIALS

SELF-MANAGEMENT EDUCATION & SUPPORT: PROGRAM DEVELOPMENT| 11-59

4. EVALUATION

Evaluation is a necessary component of all educational interventions. It is essential to determine whether goals and objectives have been achieved as planned. Has learning/ behaviour change actually occurred? To evaluate the effect of an educational process, you will need to identify and measure the desired outcomes of learning. Outcomes (results) are dependent on both structure (resources) and process (activities) (79). Structure, process and outcomes together are the important elements of evaluation (79). There is wide variation in the type and level of evidence currently used in diabetes services to evaluate outcomes of education. Methods may vary from a randomized, controlled trial to a focus group or a pre-/post-testing strategy, depending on resources and expertise available. Outcome indicators for people with diabetes who have attended educational session(s) should be concerned with how well participants are able to apply the information they have received to improve the quality of their lives and general health through individual self-care. The wide adoption of the CCM model means that outcome evaluation of diabetes SME and SMS efforts will need to consider all elements of the CCM model, not just the individual patient. In today’s complex and dynamic health systems, evaluation of quality is not a simple process, and a large range of quality models have been developed (80). In a review of evidence-based health models, Minkelman reports that there is some evidence supporting the interventions based on the CCM model taken individually, but that evidence for the model as a whole remains limited and of non-randomized quality (80). Norris, Glasgow and colleagues support Wagner’s original CCM model with the exception of adding a focus on the individual, as well as the entire population affected by the chronic condition. From a review of existing literature, they reported that effective diabetes management programs had the following characteristics (81): 1. They use a population-based systems approach. 2. They involve proactive contacts, surveillance and reminders. 3. They incorporate the individual as an active participant and use patient-centred, collaborative goal-setting. 4. They implement consistent follow-up procedures. 5. They assign important responsibilities to non-physician team members, such as nurse case managers.