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Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation

BACKGROUND: There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational gr...

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Autores principales: Sawtell, Mary, Jamieson, Liz, Wiggins, Meg, Smith, Felicity, Ingold, Anne, Hargreaves, Katrina, Khatwa, Meena, Brooks, Lucy, Thompson, Rebecca, Christie, Deborah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419460/
https://www.ncbi.nlm.nih.gov/pubmed/25969740
http://dx.doi.org/10.1136/bmjdrc-2014-000065
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author Sawtell, Mary
Jamieson, Liz
Wiggins, Meg
Smith, Felicity
Ingold, Anne
Hargreaves, Katrina
Khatwa, Meena
Brooks, Lucy
Thompson, Rebecca
Christie, Deborah
author_facet Sawtell, Mary
Jamieson, Liz
Wiggins, Meg
Smith, Felicity
Ingold, Anne
Hargreaves, Katrina
Khatwa, Meena
Brooks, Lucy
Thompson, Rebecca
Christie, Deborah
author_sort Sawtell, Mary
collection PubMed
description BACKGROUND: There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational group program, using psychological techniques, delivered primarily by diabetes nurses. Composed of four modules, it is designed for children with poor diabetic control and their parents. A mixed methods process evaluation, embedded within a cluster randomized control trial, aimed to assess the feasibility, acceptability, fidelity, and perceived impact of CASCADE. METHODS: 28 pediatric diabetes clinics across England participated and 362 children aged 8–16 years, with type 1 diabetes and a mean glycosylated hemoglobin (HbA1c) of 8.5 or above, took part. The process evaluation used a wide range of research methods. RESULTS: Of the 180 families in the intervention group, only 55 (30%) received the full program with 53% attending at least one module. Only 68% of possible groups were run. Staff found organizing the groups burdensome in terms of arranging suitable dates/times and satisfactory group composition. Some staff also reported difficulties in mastering the psychological techniques. Uptake, by families, was influenced by the number of groups run and by school, work and other commitments. Attendees described improved: family relationships; knowledge and understanding; confidence; motivation to manage the disease. The results of the trial showed that the intervention did not significantly improve HbA1c at 12 or 24 months. CONCLUSIONS: Clinic-based structured group education delivered by staff using psychological techniques had perceived benefits for parents and young people. Staff and families considered it a valuable intervention, yet uptake was poor and the burden on staff was high. Recommendations are made to inform issues related to organization, design, and delivery in order to potentially enhance the impact of CASCADE and future programs. CURRENT CONTROLLED TRIALS: ISRCTN52537669.
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spelling pubmed-44194602015-05-12 Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation Sawtell, Mary Jamieson, Liz Wiggins, Meg Smith, Felicity Ingold, Anne Hargreaves, Katrina Khatwa, Meena Brooks, Lucy Thompson, Rebecca Christie, Deborah BMJ Open Diabetes Res Care Clinical Care/Education/Nutrition/Psychosocial Research BACKGROUND: There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life. The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational group program, using psychological techniques, delivered primarily by diabetes nurses. Composed of four modules, it is designed for children with poor diabetic control and their parents. A mixed methods process evaluation, embedded within a cluster randomized control trial, aimed to assess the feasibility, acceptability, fidelity, and perceived impact of CASCADE. METHODS: 28 pediatric diabetes clinics across England participated and 362 children aged 8–16 years, with type 1 diabetes and a mean glycosylated hemoglobin (HbA1c) of 8.5 or above, took part. The process evaluation used a wide range of research methods. RESULTS: Of the 180 families in the intervention group, only 55 (30%) received the full program with 53% attending at least one module. Only 68% of possible groups were run. Staff found organizing the groups burdensome in terms of arranging suitable dates/times and satisfactory group composition. Some staff also reported difficulties in mastering the psychological techniques. Uptake, by families, was influenced by the number of groups run and by school, work and other commitments. Attendees described improved: family relationships; knowledge and understanding; confidence; motivation to manage the disease. The results of the trial showed that the intervention did not significantly improve HbA1c at 12 or 24 months. CONCLUSIONS: Clinic-based structured group education delivered by staff using psychological techniques had perceived benefits for parents and young people. Staff and families considered it a valuable intervention, yet uptake was poor and the burden on staff was high. Recommendations are made to inform issues related to organization, design, and delivery in order to potentially enhance the impact of CASCADE and future programs. CURRENT CONTROLLED TRIALS: ISRCTN52537669. BMJ Publishing Group 2015-04-28 /pmc/articles/PMC4419460/ /pubmed/25969740 http://dx.doi.org/10.1136/bmjdrc-2014-000065 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Clinical Care/Education/Nutrition/Psychosocial Research
Sawtell, Mary
Jamieson, Liz
Wiggins, Meg
Smith, Felicity
Ingold, Anne
Hargreaves, Katrina
Khatwa, Meena
Brooks, Lucy
Thompson, Rebecca
Christie, Deborah
Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title_full Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title_fullStr Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title_full_unstemmed Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title_short Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
title_sort implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation
topic Clinical Care/Education/Nutrition/Psychosocial Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419460/
https://www.ncbi.nlm.nih.gov/pubmed/25969740
http://dx.doi.org/10.1136/bmjdrc-2014-000065
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