Tuesday, 30 June 2015

When is Structured Education not Structured Education?

Back in March we praised a report by the All Party Parliamentary Group on Diabetes for their timely and important report on the state of diabetes education. We asked ‘what difference will this report make?’

It would appear that the jury is still out on that question, if Diabetes UK’s latest briefing report is anything to go by. Entitled ‘Diabetes Education: the big missed opportunity in diabetes care’, it explains that although diabetes education is recommended, it is hardly provided or attended. In a separate Diabetes UK survey, released for the recent Diabetes Week, 42% of people with Type 2 diabetes reported themselves to be unconfident about managing their condition.

It’s pleasing to see these messages being highlighted again, much as we and others have done many times in this blog and in other publications. We await the updated NICE guidance on Type 1 and Type 2 diabetes, to see if there is any emphasis at this level which could improve the situation for so many people with diabetes who are lacking the ‘tools to do the job’ of looking after a complex and at times, complicated, condition. Although, having seen the drafts of these guidelines, to be honest, we are not holding our breath here at Successful Diabetes! Diabetes UK are also campaigning for people to lobby their MPs about the issue, so we can hope that this personal approach brings much needed attention instead

So, whilst Diabetes UK’s briefing and its echo of many other calls to action in respect of the parlous state of diabetes education is welcome, we are bound to say that unfortunately it doesn’t tell the whole story in relation to the definition or availability of structured education. Here’s why:

It defines level 3, or structured, education solely in terms of group education. To our knowledge, there is nothing in the definition of structured education that says it has to be provided to groups of people. In fact, one of he earliest definitions of structured education, from the 2003 Technology Appraisal from NICE, says that it is ‘a planned and graded programme that is comprehensive in scope, flexible in content, responsive to an individuals clinical and psychological needs, and adaptable to his or her educational and cultural background’ (p 14). To be fair, the Appraisal mentions group education as being a principle, but also states ‘unless group work is considered unsuitable for an individual’ (p 4) and that ‘the aim of education for people with diabetes is to improve their knowledge and skills, enabling them to take control over their own condition’ (p 7). In defining structured education in this way, Diabetes UK have themselves missed an important opportunity to consider and acknowledge successful 1-1 structured education programmes, such as our own Diabetes Manual Programme.

As we’ve mentioned before, it’s rare that the Diabetes Manual Programme, a fully evidenced, educational intervention based on self-efficacy (otherwise known as confidence) principles, gets a look in, in such august reports. This needs to change, as the world has done so much since these early-cited documents were published.

Diabetes UK Briefing

Diabetes Manual Programme