Distance learning for patients with diabetes

Journal of Diabetes Nursing, Feb, 2003 by Julie Whitehead, Jennefer Richmond

Introduction

Diabetes education should increase knowledge, enhance skills and attitudes, improve quality of life and prevent complications associated with the disease (Hicks, 1999). However, with around 3% of the UK population having diabetes, (Audit Commission, 2000) this presents an enormous task for the educators. The National Service Framework (NSF) for Diabetes delivery strategy (2002) clearly indicates the need for a structured approach to education of people with diabetes to facilitate self-care. Indeed, Standard 3 of the NSF is aimed specifically at empowering people with diabetes to take control of their own lives. Distance or 'open' learning may provide the answer to reaching such a large audience with relatively few educators.

KEY WORDS

* Distance learning

* Flexibility

* Self-management

* Patient empowerment

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A substantial number of diabetes patients receive little or no education on diabetes--this is a popular argument heard today. Similarly, many patients are given confusing or conflicting advice by professionals, leaving them disillusioned and unsure of the way forward. One-to-one education is time-consuming and impossible to carry out with every person with diabetes. Group education sessions are helpful (if there are rooms available), but not all patients are able, or want, to attend the sessions on a regular basis. Rankin and Stallings (1990) state that:

  'Feeling powerless is perhaps the most devastating aspect of illness
  for a patient. Patient education is the most effective means of
  returning control to the patient by reducing feelings of helplessness
  and enhancing the ability to be the chief decision maker in the
  management of one's health and illness problems'.

So what is the answer? How can healthcare professionals provide a comprehensive programme of education to as many people as possible, with limited resources and manpower? How can we ensure that all patients are given the same access to information and understand it? A possible answer lies in distance learning.

What is distance learning?

Distance learning has long been recognised as an effective and flexible way of delivering education to those who are unable to attend a learning centre on a regular basis, allowing individuals to take more responsibility for their own learning (Murphy, 1995). However, the use of distance learning in relation to patient teaching has been limited.

Robinson and Clarke (1992) argue that 'open' learning provides the learner with some degree of control over the learning content, with technology providing the primary teaching medium, thereby allowing the learning to take place away from the education centre.

In contrast, Rumble (1989) suggests that 'open' learning is where the learner sets his own objectives, determines the learning content and negotiates the provision of services to help.

The terms 'distance' and 'open' learning, have tended to be used interchangeably. For the purposes of this article we have chosen to use the term 'distance learning' in keeping with Murphy's definition (Murphy, 1995). With regard to the use of such a system to educate patients with diabetes, we suggest that it needs to have all of the following qualities:

* Flexibility -- so that patients may choose to study whichever parts of the curriculum they wish, and in whichever order they wish.

* Objectives that are negotiated or set by the patients themselves.

* A learning environment in which the patient feels most comfortable.

Why change from existing methods?

A survey by Raleigh and Clifford (2002) has clearly demonstrated that significant numbers of people are not well informed about their diabetes and many are not receiving any education. To some extent this may be due to lack of organisation or shortage of resources on the part of health professionals, resulting in a failure to deliver education to those in need.

However, Raleigh and Clifford (2002) found that while patients want more information, many are reluctant to attend group education sessions. This is supported by Cooper et al (2002) who found that only 40% of patients who were asked to participate in educational workshops were willing to take part. The reasons for non-participation included lack of time and lack of interest.

Fletcher (1987) points out that increasing knowledge does not necessarily lead to a change in behaviour, and Hampson (1997) suggests that people need to be convinced of the personal benefits of change. Developing a package that enables people to tailor learning to their individual need may be one way of going beyond simply enhancing knowledge and helping people to recognise the significance of learning about diabetes in relation to their own lives.

As an alternative to simple information giving, Goodall and Halford (1991) found that behavioural interventions with patients with type 2 diabetes failed because supervision and reinforcement were necessary to maintain change, which is time-consuming for health professionals. Additionally, Brown (1992) found that changes brought about by education fall off after about 6 months, and suggested that we need to be more creative in the way we teach patients.