Diabetes Education in

Egypt

A Critical Review

By

Prof. Morsi Arab

Pathways and Targets in Diabetes Education

Planning Who Educates ? The Recipient Patient

* physician * understand

* Nurse * Self manage

* pharmacist * prevent

Education * Specialists: complications

Program - Diet * improve quality

Planner - exercise. of life

- foot care, etc

* Prof. Educator

* Volunteer

* Piers (in groups)

* Family member

( e.gother)

Diabetes Education

Diabetes Education = 50% of success

in management: control of diabetes

and prevention of its complications.

:Successful EducationIndicators of Some

- Less hospital admissions (esp. for

DKA , foot ulcers & hypoglyc.

Etc.).

- Less incidence of amputations

- More frequent good glycemic

controls ….

Objectives

Evaluation Strategy

Education

in Diabetes bjectives In planning the o Education

1- Decide the Target : to educate patients ,

physicians . nurses , or public (awareness )

then select the required objectives

2- Cover All Education Domains

a- knowledge

b- Skills

c- attitudes

3- Consider from which learner ‘s background

4- and , to achieve what level of competence

Consider ensuring the basic

competences in the Educator :

( physician , nurse , or other HC persons ,

professional educator , or pier ( precautions !!).)

1. Accurate knowledge of the contents(diabetes).

2. Professional Education skills (viz)

3. Performs as a member in the education Team

4. Beware of the biased educator !.

rBackground of The LearneConsider the

1. his General educational standard:,

(e.g. illiteracy)

2. his Specific knowledge about diabetes:

( not necessarily correlated with his general

education level……?

Knowledge accuracy in relation to the

duration of diabetes ?

- not necessarily nil at the onset …..

- and not necessarily satisfactory

after a long duration with diabetes .

).very frequently wrong or distorted (…...

- LearnerConsidering the background of the

.) (cont

3.his psychological status “stage of acceptance”

4.his diabetes stage : (controlled / uncontrolled/

complicated / handicapped ?)

5.his basic attitudes , perception and belief about

the cause of his diabetes, consequences ,

value of treatment, cost /benefit , slavery to

his specific habits (e.g. smoking).

Not concerned,

unlikely to benefit

from education

I am not sick 1- Denial

Mis-interprets the

informat. given.

Fails to remeber .

Why me? 2- Revolt

Ready to learn.

Demands to learn

OK , but I know

what to do

3-Bargain

readiness to learn at and Patient acceptance

states psycholigicaldifferent

Also ready to

learn

I am sick , I shall

take Rx,but shall I

be able to cope?

4- Depression

Most receptive :

attentive, ready to

discuss ,accepts

suggestions &

corrections

I shall live with it

……

5- Acceptance

Psychological acceptance and readiness to

learn (cont.)

V Aids in Pt Education-Pitfalls in the use of A

(Diet sheet, Handbooks , Pamphlets , Slides.

Video tapes , Self evaluation check lists ,

computer programs with Q & A, etc)

1. must be selected to meet the objectives and to

match the learner’s abilities.

2. avoid : too complex leaflets – long videos

(optimal is 7-10min with only 2-3 concepts)

contradictory information . or badly translated

material from foreign sources .)

3. should not be intended to replace and escape

from direct talking to people.

Specific Skills required in conducting

:certain education sessions

- In One-to-One Education:

(listen , motivate, individualize to stage,

not too much, reward more than blame,etc.)

- In Group Education:

- Size of the group.

- Group dynamics (+ve & -ve behaviours)

- Educate, not teach (active participation)

Pitfalls in diabetes education through the

Media (Mass Group Education)

- personal propaganda

- business promotions

- causing panic

- false news on premature studies

- individual advices to replace direct contact

with the physician ……….etc

The Uncompliant Patient resents

education:

Causes of uncompliance :

1- at the early stages of denial , protest & refusal

2- when slave to a habit ; smoking , exercise ,

eating……..

3- if adherent to his belief about the cause of

his diabetes

(cont ) UncomplianceCauses of

after repeated frustration and depression -4

failures to reach the set goals ;

- in body wt reduction

- in glycemic control parameters

or by social, economic stresstransient -5

intercurrent illness.

N:B: Therefore ,changing the attitude to

improve compliance should be

individualized after knowing its cause.

Indicators of the poor performance of

:the physicians as educators in Egypt patients their observations onindirectly, from

.un control glycemicHigh prev. of -1

e.g. parameters other related of Un control -2

hypertension, hyper-cholestrolemia.etc.

hospital admissionsof frequency High -3

for preventable complications ; DKA,

Hypoglyc , Foot infection., etc

poor or distortedFrom their patients’ -4

(e.g. about syringes , typesknowledge

of insulin etc. which means poor education ).

inCauses of failure The most Common

prespectiveeducation from patient

their cultural to unsuitable Objectives -1

background , attitudes, beliefs , psychological

)not individualizedstatus, stage of illness, etc.(

to the patient . not achievableObjectives

skillswithout proper educational Educators -2

and/or sufficient knowledge of the program

content (diabetes).

of The Main Causes of National inadequacy

in Egypt: ProgrammesEducation

1. Lack of a national coordination of education

programs in place and time, duplication

and mal - distribution .

2.Lack of professional skills of the Educators

3. Wrong planning in targets and in selection

of the suitable objectives.

(Education Parties ): benefit-cost. Poor 4

* minimal attendance

* false certification

* too short courses

Causes of National inadequacy of Education

(cont..): Programmes

5.Unsuitable content to audience (confusing

. theoreticalhigh teceducation with basic

knowledge ).

6. Lack of, poor quality or misleading

education material (e.g. badly translated

guide books biased by commercial interest.

7. Biased Education ( with conflicts of interest ,

business promoting and propaganda . .)

8. Lack of national collaboration to produce:

for education programlines -unified guide

.

studies evaluationup and follow . lack of 9

on the outcomes of education courses.

to specific accountability. Lack of 10

references and judgment authorities

Causes of National inadequacy of Education

): (cont..in Egypt Programmes

Thank You