Diabetes Group

Education
Jonathan Tellier
 Objectives
➢ Identify the need for diabetes education.

➢ Understand the barriers specific to the mental health

population.

➢ Understand the results of the project.

➢ Consider the recommendations.

 Purpose
● DSH-P has a large population of diabetics.

● No current diabetes education group exists.

● Objective: to identify barriers to implementing education.

 Types of Diabetes Mellitus
● Type one Diabetes Mellitus

● Cell-mediated autoimmune response .

● Type two Diabetes Mellitus

● Inadequate insulin production.

● Decreased insulin sensitivity.

● Gestational Diabetes

● Alteration in insulin secretion.

● Alteration in glucose, lipid, and amino acid metabolism.

 Diabetes Prevalence
General population

● 9.4% of the U.S. population in 2015.

● 7th leading cause of death.
Schizophrenic Patients

● 15% have diabetes.

● Glucose intolerance in 25% of
patients.

Annamlai et al. 2017

 Obesity prevalence
● 39.2% of the U.S. population are obese.

● 50% of patients with schizophrenia are obese.

● Unhealthy diets.
● Inadequate physical activity.
● Lower educational level.
● Sub-optimal living situations.

Annamlai et al. 2017

CDC 2018
 Additional risk factors
❖ Multifactorial:

➢ Antipsychotics- cause weight gain

and glucose intolerance.
➢ Unhealthy diets and Inadequate
physical activity due to low
education level, sub-optimal living
situation, and socioeconomic status.
➢ Schizophrenia- inflammatory
markers are seen in both
schizophrenia and metabolic
syndrome.
Annamlai et al. 2017
 Impact on health
● Patients with psychiatric conditions have an average life
span 20-25 years shorter than the general public or a
mortality rate 4 times higher.

● This is caused mostly by physical illness.

• Atherosclerosis
• HTN
• Stroke

Annamlai et al. 2017

 Fasting glucose
● One study found antipsychotics to have no effect on
fasting glucose.

● Other findings:
• Increases in fasting glucose was independently associated
with antidepressants, cholinesterase inhibitor, and valproate
use.
• 10% of all patients in the study have untreated or
undertreated fasting hyperglycemia.

Abitbol et al. 2017

 Barriers Found in Research
● Low motivation
● Apathy
● Cognitive deficits
● Poor self-efficacy
● Length of stay
● Age
 Schizophrenia
❖ Symptoms as barriers:
➢ Apathy- Many people with schizophrenia express little
interest in the events surrounding them.
➢ Low motivation/Avolition- The severe lack of initiative
to accomplish certain tasks.
➢ Cognitive deficits- affect the ability to engage in real
world tasks, memory, and attention.

Abitibol et al. 2017

 Self-efficacy
● One study found self-efficacy to be low among inmates.
● Bandura’s four sources of efficacy:
• Past performance- mastering a skill.
• Verbal persuasion- peer recognition of skills.
• Vicarious experiences- observation of others success.
• Physiological/emotional state- Ex: how well a person sleeps/
feeling or mood.
 Writing Self-efficacy
● Is a significant predictor of participation
in education.
● When compared to reading self-efficacy
patients are not as aware of their
difficulties reading as they are their
difficulties writing.
● Those that are able to identify they have
reading and spelling problems were
twice as likely to participate in
education.
 Length of stay
● Patients with a long sentence may have enough time to
possibly plan an education and utilize it upon their release.

● Prison education may need to be adapted to the needs of a

patient with a shorter sentence.
● If a patient has a very long sentence this can be de-
motivating because patients do not see opportunities for
using the education.
 Age
● The older population is less likely to participate in
education.

● This may be affected by the length of sentence.

 Participants
❖ Participants in this study were chosen based on their
medication prescription and unit assignment.
■ Total patients who received questionnaire= 400
■ Total possible sample size= 133
■ Sample size= 18

❖ The only participants considered were those that

recognize they have diabetes.
 Method of evaluation
● A questionnaire was delivered to
assess barriers previously discussed.

● Questions:
● Modified self-efficacy scale
● Length of time spent at DSH-P
● Age
● Participation in groups
● Perceived ability to read and write
 Method of disbursement
❖ Med pass?
● Discussed with leads this may interfere
with patient compliance of medication.
● This imposes strain on the unit staff.

❖ Recommendations from Leads and staff.

● During lunch because all patients are
present, and staff can help pass out
questionnaires.
 General self-efficacy
● Belief that you can handle situations so as to successfully

attain your goals.

● The scale is correlated to emotion optimism, work,

satisfaction. Negative coefficients were found for

depression, stress, health complaints, burnout, and
anxiety.
● Total score ranges between 10-40, with a higher score

indicating more self-efficacy.

Schwarzer et al. (1995)

 Patient Survey Results
Length of stay: 12.7 years

Average Age: 49.4 years

Reading/Writing difficulty:
50%

Groups: 78% participate in

groups

General Self-Efficacy: 32
 Discussion
● We found that patients present with an average self-
efficacy score, low motivation, apathy, and cognitive
deficits.
● RDs and level of care staff:
● Inadequate staffing,
● Poor support systems
● Low self-efficacy to read and write as barriers.
 Average Self-Efficacy
Patients scored a 16 on the modified General Self-Efficacy
scale.

● This was multiplied by 2 to get a score of 32.

● This score falls within the average range.

● The implication is that the patients show the same
amount of confidence to successfully handle situations as
most people.

Jonesa et al. 2013

 Writing Self-Efficacy
Research found the perceived ability to write can help predict
the amount of participation.

● 50% of patients acknowledge they have writing

difficulties.
● Patients asked for assistance when filling out the
questionnaire.
● Staff also recognize that patients have a hard time reading
and writing.

Jonesa et al. 2013

 Sentence length
● Mean length of stay=12.7 years

● Range= 3 months-35 years

● Median= 11 years

Jonesa et al. 2013

 Implications of Age
Mean= 49.4 years

● This study indicated the older population was more likely

to participate in education.

● However, literature review found older adults less likely to

participate in education.

Jonesa et al. 2013

 Group Participation
● 78% of participants participate in health related
groups already.

● Groups considered

● Wow, Lifestyle Balance, and exercise groups

● Targeting the population of diabetics that already

show an appreciation for education could improve
participation.

Mensing et al. 2003

 Dietitian survey
Similar questions were asked:

● Self-efficacy of patients.

● Perceived reading and writing ability of the patients.

● Free text option for other potential barriers.

This was delivered and analyzed through survey monkey.

 Self efficacy
● 100% of respondents identified self-efficacy as a barrier to
education.

● This is in agreement with literature, but not the findings

from the patient questionnaire.
 Writing Skills
● 40% of respondents identify writing skills as a barrier to
education.
● The patients and staff have similar views on perceived
writing skills.
 Reading Skills
● Respondents identified reading skills as a barrier to
education.
● Patients are able to identify they have a reading problem
as well.
 Other problems identified
❖ 4 dietitians- lack of motivation as a barrier.

❖ 5 dietitians- inadequate staffing or schedule conflicts.

❖ 2 dietitians- poor support systems at the hospital.

❖ 1 dietitian-

■ Mental state related to side effects of medications.

■ Health is a low priority.

 Implications
❖ The other problems identified by dietitians were also
found in literature reviewed.

❖ Staff on the unit also verbally agreed with barriers

mentioned.
■ Staffing
■ Low motivation
■ Reading/Writing skills
 Modes of education
● Multimedia with educational tools.
● Nutritional therapy.
● These modes of education when
used in combination have a greater
degree of impact on health.

Lopez et al. 2017

 Group vs. Individual Education
● Groups save time.
● Individual education is costly.
● One study found patient
focused groups increase self-
efficacy and feelings of control
over medical conditions.

Mensing et al. 2003

 Limitations
● This test population should not be
generalized for other educational
groups.

● Size of participating groups is

small.

● Alterations to the length of the

self-efficacy test.
 Additional Recommendations
● Staff believe building based
education would be the best
option.

● Room C103 in N building.

● Assessments should be done by

dietitians every 6 months.

Gordon (2018)
 References
Abitbol, R., Rej, S., Segal, M., Looper, K. (2017). Diabetes mellitus onset in geriatric patients: does long-term atypical antipsychotic exposure increase risk?

Psychogeriatrics, 15: 43-50. doi: 10.1111/psyg.12081

Annamlai, A., Kosir, U., Tek, C. (2017). Prevalence of obesity and diabetes in patients with schizophrenia. World Journal of Diabetes. 8(8) 390-396. doi:

10.4239/wjd.v8.i8.390

Jonesa, L.., Mangerb, T., Eikland, O., Asbjomsen, A. (2013). Participation in Prison Education: Is it a Question of Reading and Writing Self-Efficacy Rather than Actual

Skills? The Journal of Correctional Education, 64(2). Retrieved from

http://web.b.ebscohost.comC.portal.lib.fit.edu/ehost/pdfviewer/pdfviewer?vid=13&sid=98641933-d66c-4539-8c54-5d6b070ba91e%40pdc-v-sessmgr01

Lopez, V, L., Torres, A., Bravo, P., Gil, J., Klunder, M., Pena, J., (2017). Multimedia education program and nutrition therapy improving HbA1c, weight, and lipid profile of

patients with type 2 diabetes: a randomized clinical trial. Endocrine, 58:236-245. doi: 10.1007ls12020-017-1416-0

Mensing, C., Norris, S. (2003). Group Education in Diabetes: Effectiveness and Implementation. Diabetes journal, 16(2). Retrieved from

http://spectrum.diabetesjournals.org/content/16/2/96

Gordon, B. (2018). How an RDN can help with Diabetes. https://www.eatright.org/health/diseases-and-conditions/diabetes/how-an-rdn-can-help-with-diabetes

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. in J. Weinman, S. Wright, & M. Johnsont, Measures in health psychology: A user’s portoflio. Causal

and control beliegs (pp. 35-37). Windsor, UK: NFER-NELSON.