A need-based approach to self-management education for adults with co-morbid diabetes and chronic kidney disease

摘要

BackgroundThe terms ‘self-management education’, ‘self-management support’ and ‘patient education’ are often used interchangeably especially when describing the management of patients with diabetes. Diabetes self-management education (DSME) is designed to help patients develop skills and techniques to enhance diabetes self-care [1,2,3] leading to improved clinical and self-reported outcomes such as health related quality of life [4]. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviours needed to self-manage [2, 3]. In contrast, patient education primarily involves increasing a patient’s knowledge about a disease in order to change behaviour [5]. Self-management education underpinned by self-management support and patient education are paramount for acquisition of problem-solving skills that empower patients to self-care [6, 7].Assessment of self-management education needs among patients with chronic diseases such as diabetes [8] and chronic kidney disease (CKD) [9] has indicated a wide variation between the information made available to patients and their specific knowledge needs. For example, studies in patients with CKD [10, 11] have highlighted gaps in awareness of the disease while another study reported poor self-management education levels among patients with diabetes [8].Patient involvement in the development of self-management education resources may ensure content is relevant, understandable and actionable. Indeed, previous studies among patients with diabetes [12, 13] highlight the importance of seeking patients’ perspectives on what they value about an education intervention and the requirement for a needs assessment before the development of self-management education resources. One study [14] suggested the importance of considering patients’ different knowledge ‘starting points’ and the origins of their knowledge deficits as these are likely to inform how patients engage with, and comprehend education.Although patient self-management education needs have been assessed for single diseases such as diabetes [15] and CKD [16], they have not been assessed for complex co-morbid conditions such as diabetes and CKD. This is despite the fact that self-management may be particularly important for the outcomes of this group of patients [17]. People with complex co-morbid diseases may have competing self-management strategies and challenges [18], which put them at risk of negating the management of other conditions especially later diagnoses. This can be explained by the concept of “dual task theory” where individuals are likely to perform self-care tasks for conditions in which they have an emotional investment at the expense of others [19]. For example, patients with diabetes and CKD may pay particular attention to the management of diabetes at the expense of kidney disease. In this regard, robust, pragmatic and patient-centred self-management educational tools for patients with co-morbid diabetes and CKD are required.The overarching objectives of the present study were to 1) qualitatively determine the self-management education needs for patients with diabetes and CKD and 2) co-develop an educational resource meeting the self-management education needs of patients with co-morbid diabetes and CKD.