Patient-education and compliance in non-insulin-dependent diabetes mellitus.
This prospective study investigated many compliance-related
aspects involving a population of Type II (non-insulin-dependent)
diabetics, who attended the out-patients' clinic of a District
General hospital. The investigations were undertaken from both
qualitative and quantitative perspectives; activities within the
clinic were observed and knowledge levels concerning diabetes
mellitus were measured.
A teaching programme was constructed, drawing on general
educational principles; each stage was subjected to analysis and
evaluation. Information, teaching and counselling skills were
incorporated and a quality assurance model described.
Two groups of subjects - one diagnosed less than one year
(n=20), the other diagnosed more than one year (n=18) - were
entered into a teaching programme; weight change was chosen as
the study variable. Three interventions were planned for each
subject. No statistically significant differences were found
between the study groups and an historical control group, but
clinically significant trends towards the target weight were
recorded. Following the intervention study, a clinic-specific
video was made, which was positively evaluated by subjects after
it was viewed in their own homes.
An innovative method of analysis was applied to healthbelief attributes, including vulnerability and social support
-dynamic concept analysis (Kontiainen, 1973) - and models were
constructed to determine whether there were common patterns of
interview response from which prediction of compliance with
clinical advice could be deduced. From the analysis it was
concluded that computerised models could be constructed, which
would be used in the clinic setting to predict, and subsequently
monitor and guide, the behaviour required of individuals with
NIDDM. The home viewing of clinic-specific videos would provide
an adjunct to effective management through the dissemination of
information outside the immediate physician-patient interaction.
The main aim of Type II diabetes management is control of
body weight. A means of depicting movement out of the obesity
grading (Garrow and Webster, 1985) was devised, which could be
utilised in a collaborative way by the health care professional
and the diabetic person.
From this longitudinal study it was concluded that the
unique educational needs of individuals must be met by a range
of inter-linked skills, methods and materials, if a solution
to the non-compliance problem is to be found