Desirable diabetes education programme for type 2 diabetes adults at a tertiary hospital: insights from stakeholders

Background: Patient education is a core component of diabetes care. The education provided should be relevant to the target group as well as be offered in a structured manner. Engaging the persons with diabetes and their health care providers can obtain useful information regarding the education needs as well insight on what a structured education programme could entail.
Aim: To describe the desirable characteristics of nutrition focused diabetes education programme as perceived by type 2 diabetes (T2DM) adults and health professionals serving them at a tertiary care setting. This was to inform the adaptation of nutrition education programme (NEP) that was previously implemented at primary care with non-insulin dependent T2DM.

Method: This qualitative study was implemented at an outpatient diabetes clinic of a teaching tertiary hospital of the University of Pretoria (South Africa) from February to May 2016. Participants were T2DM adults (40-70 years) with at least one year of living with diabetes and health professionals who had worked with the patients for at least 6-months. Samples were attained through convenience sampling. Five focus group discussions generated data from the patients. Self-administered open ended questionnaire obtained data from health professionals. Thematic framework was used for data analysis. The study had ethical approval from Faculty of Health Sciences, Research Ethics Committee, University of Pretoria (no. 4/2016).

Results: Twenty-eight patients [mean age 59±9 years; diabetes duration of 1-37 years (median 13 years); majority (82%) on insulin therapy; 11 females] and 10 health professionals [3 doctors, 5 dietitians, 2 nurses; 6 with over one year serving the patients; 7 females] participated. Six major themes with several subthemes emerged from the two participant groups. The themes include preferred content for the education programme (e.g. diabetes basics, diet, exercise, other self-care, stress management), meetings ideas (monthly preferred to weekly; morning sessions; 1-2 hours), delivery format (group e.g. for social support and learning from others ), delivery to enhance learning (participatory methods e.g. group activities and food tasting sessions, demonstrations, use of visuals, education materials, use of simple language), support for behaviour change (e.g. involving family, blood glucose monitoring)and educator characteristics (e.g. knowledgeable, positive attitudes). One additional theme, namely keeping participants motivated (e.g. vicarious reinforcement through testimonials from those with success stories; good speakers; reminders) emerged from the patient group. On some of themes common to both participant groups some differences were observed. For example on content related to diet, portion control and meal regularity as a topic was only suggested by health professionals.
Conclusions: Involving key stakeholders provided comprehensive insight on desirable education programme characteristics relevant to the target population due to the common as well as unique insights from each group of stakeholders. Most of the identified aspects were similar to those in the original NEP thereby confirming programme contextual relevance and the appropriateness thereof. In adapting the NEP, the differing aspects have been incorporated to enhance its fit to the new setting.