Nomograms Predicting Self-Regulated Learning Levels in Chinese Undergraduate Medical Students.

PURPOSE: The purpose of this study was to construct a multi-center cross-sectional study to predict self-regulated learning (SRL) levels of Chinese medical undergraduates. METHODS: We selected medical undergraduates by random sampling from five universities in mainland China. The classical regression methods (logistic regression and Lasso regression) and machine learning model were combined to identify the most significant predictors of SRL levels. Nomograms were built based on multivariable models. The accuracy, discrimination, and generalization of our nomograms were evaluated by the receiver operating characteristic curves (ROC) and the calibration curves and a high quality external validation. RESULTS: There were 2052 medical undergraduates from five universities in mainland China initially. The nomograms constructed based on the non-overfitting multivariable models were verified by internal validation (C-index: learning motivation: 0.736; learning strategy: 0.744) and external validation (C-index: learning motivation: 0.986; learning strategy: 1.000), showing decent prediction accuracy, discrimination, and generalization. CONCLUSION: Comprehensive nomograms constructed in this study were useful and convenient tools to evaluate the SRL levels of undergraduate medical students in China.

Can a community-based peer-led diabetic self-management programme be effective: 12-week evaluation.

AIMS AND OBJECTIVES: To evaluate a self-management programme collaborating with communities and mobilising peer leaders for patients with diabetes in mainland China. BACKGROUND: The rapidly increasing diabetic epidemic is an overwhelming burden in China. Diabetic self-management programmes that are both effective and feasible despite health resource shortages should be developed and evaluated. DESIGN: Quasi-experimental. METHODS: In total, 181 patients with diabetes completed the study (89 in the experimental group and 92 in the control group). Diabetic instruction and peer-led group activities were two major parts of the programme. Outcome variables, including self-efficacy, social support, self-management behaviours and quality of life, were measured. Participants' perceptions towards the programme were also collected. anova/ancova and content analysis were used for data analysis. RESULTS: Social support, self-efficacy and self-management behaviours significantly improved during the study period. Although quality of life did not change significantly, the participants provided positive feedback for the programme. CONCLUSIONS: The effectiveness of this programme was partially verified. The delivery mode, through trained peer leaders and collaboration with communities, appeared to be feasible. Using a cluster randomised controlled design with full cost-effectiveness analysis would provide a more rigorous examination for this programme. RELEVANCE TO CLINICAL PRACTICE: This study adds to the growing evidence of the importance of self-efficacy and social support as a mechanism for achieving behavioural change. This programme appears to be promising in promoting diabetic self-management in China and may be applied to individuals with other chronic diseases and dwelling in other regions.

Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China.

Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.

Peer-led diabetes self-management programme for community-dwelling older people in China: study protocol for a quasi-experimental design.

AIM: A protocol for a new peer-led self-management programme for community-dwelling older people with diabetes in Shanghai, China. BACKGROUND: The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. DESIGN: Quasi-experimental. METHODS: This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. DISCUSSION: This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.