Empowering diabetes out-patients with structured education: Short-term andlong-term effects of functional insulin treatment on perceived control over diabetes
K. Howorka et al., Empowering diabetes out-patients with structured education: Short-term andlong-term effects of functional insulin treatment on perceived control over diabetes, J PSYCHOSOM, 48(1), 2000, pp. 37-44
Objective: To investigate short-term and long-term effects of structured ou
tpatient education for Functional Insulin Treatment (FIT: selective insulin
dosages for eating, fasting or correcting hyperglycaemia) on perceived con
trol over diabetes and related health beliefs. FIT was thought to influence
the perception of self-efficacy in diabetes, in contrast to conventional t
reatment, based on scheduled, rigid food intake and insulin delivery-it all
ows flexible eating, provided independent control of glycemia. Methods: Str
uctured, comprehensive, outpatient group training in FIT for selective use
of insulin either for eating, fasting or correction included practical "ins
ulin games." The FIT program focused on everyday criteria for choices of in
sulin dosages and thus on the patient's ability to execute his/her newly ga
ined flexible treatment to his/her everyday life while preventing acute and
late complications. To evaluate effects of FIT on "Perceived Control over
Diabetes" and related "Health Beliefs Concerning Diabetes" (Bradley's quest
ionnaires, 1984), a fully randomized shortterm controlled Study 1 (four wee
ks, 32 patients), and long term uncontrolled pilot Study 2 (three years, 68
patients) were performed. Results: The short-term study revealed that FIT
induced the feeling of independence from situational control while self-man
aging diabetes. In the long-term study, the patients were increasingly free
d from the feeling of being under the control of physician and treatment-re
lated restrictions, which-together with higher perceived self-efficacy-cont
ributed to the feeling of "empowerment." This was associated with high trea
tment satisfaction and significant improvement of glycemic control. Conclus
ion: Structured out-patient group training for FIT results in measurable im
provement of patients' perceived control over diabetes and self-efficacy. (
C) 2000 Elsevier Science Inc. All rights reserved.