Training lay health educators to conduct a church-based weight-loss program for African American women.

PURPOSE: Community-based lay health educators have been utilized in a range of settings and with a variety of health issues. However, little has been published about the specifics of training lay health educators to effectively deliver community-based programs. This paper describes the training used to prepare volunteer, church-based lay health educators to conduct a community-based weight-loss program, and the evaluation of that training. METHODS: After recruitment through their respective churches, volunteer lay health educators were given structured training in how to conduct the PATHWAYS weight-loss program. Program sessions were observed to monitor program delivery, and participation rates and weight loss were evaluated. RESULTS: The lay health educators were highly consistent in their delivery of the program content. Participant attendance was high and virtually all of the participants completed the program. Participant weight loss averaged 8.3 pounds, which correlated with session attendance. CONCLUSIONS: Given training appropriate to the structure of the program and specific to the targeted health behavior, lay health educators can reliably and effectively administer even rather complex programs.

Development of the diabetes problem-solving measure for adolescents.

PURPOSE: This paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA). METHODS: The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument. RESULTS: The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity. CONCLUSIONS: The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.

Quality of diabetes care in community health centers.

OBJECTIVES: This study assessed the quality of diabetes care in community health centers. METHODS: In 55 midwestern community health centers, we reviewed the charts of 2865 diabetic adults for American Diabetes Association measures of quality. RESULTS: On average, 70% of the patients in each community health center had measurements of glycosylated hemoglobin, 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. The average glycosylated hemoglobin value per community health center was 8.6%. Practice guidelines were independently associated with higher quality of care. CONCLUSIONS: Rates of adherence to process measures of quality were relatively low among community health centers, compared with the targets established by the American Diabetes Association.

Interview strategies commonly used by pediatricians.

OBJECTIVES: To describe the pediatric interview as it is conducted in different practice settings and with children ranging in age from infancy to adolescence, and to identify pediatric history-taking strategies that varied across age groups. PARTICIPANTS AND METHODS: A self-administered survey was designed and mailed to a group of pediatricians in the Chicago metropolitan area to assess commonly used strategies in the pediatric interview across varied patient ages and settings. The pediatricians sampled varied by geographic location as well as by practice setting. RESULTS: Results of the survey indicated that pediatricians use common strategies for establishing rapport, calming the disruptive child, and obtaining information from the child within particular age groups, but vary these strategies as the child matures. CONCLUSIONS: The findings substantiate the influence of the developmental stage of the child on interview strategies used by pediatricians. Implications pertaining to development of a standardized teaching curriculum for the pediatric interview are also discussed.

Increasing children's responsibility for diabetes self-care: the In Control study.

The purpose of this pilot study was to test the hypothesis that children can learn to become more independent in their own diabetes self-management without compromising their metabolic control. Twenty-four children (ages 8 to 12 years) with insulin-dependent diabetes mellitus (IDDM) were matched by age and race, then randomly assigned either to a 6-week, self-management education program (experimental) or to receive usual care (control). A questionnaire was administered to the parents to determine the frequency with which 35 diabetes management behaviors were performed and the degree to which children assumed responsibility for these behaviors. Glycohemoglobin levels were monitored at baseline and at posttreatment, 12 weeks after baseline. At the posttreatment, children in the experimental group were found to be assuming significantly more responsibility for their diabetes self-care than were children in the control group. No decrease in the frequency with which self-care behaviors were performed was observed, and metabolic control was maintained. The results suggest that a diabetes self-management education program for children ages 8 to 12 years can be effective in facilitating children becoming more responsible for their own diabetes management.

Dissemination of a continuing education program in diabetes to health care professionals.

A goal of the Diabetes Research and Training Centers (DRTCs) is to translate advances in diabetes research into improved patient care by providing innovative, state-of-the-art training for health care professionals. This paper is a report on a collaborative DRTC-AADE training project. A 2-day diabetes program developed by the Chicago DRTC was packaged as a Workshop Instructor's Guide with accompanying slides and materials. AADE faculty observed the workshop presented by DRTC faculty and subsequently presented the workshop themselves. The evaluation design involved comparing a workshop presented by the DRTC faculty with a workshop presented by faculty from AADE. Three components were included in the evaluation: the participants' evaluation, a commitment-to-change evaluation, and the faculty observations. When comparing workshops, few differences were observed in participants' or faculty observers' evaluations. Moreover, participants at both workshops were equally successful at meeting goals related to improving their diabetes education practice behaviors. Dissemination of the program has been expanded and the workshop has become part of AADE's national continuing education efforts.

Development of a knowledge test in the science of prevention of lung diseases.

We developed a 50-item multiple choice test to assess knowledge of preventive pulmonary medicine. We derived the content of test items from a comprehensive preventive pulmonary curriculum, which we developed. The test was administered to 167 medical students, residents, and practicing physicians to establish its psychometric properties and to determine if the test scores discriminated between different levels of training. Using this sample, the reliability of the test was 0.86, and the test significantly differentiated between levels of training in pulmonary medicine. We are using this multiple choice test to assess changes in knowledge of second-year medical students and of fourth-year medical students completing a pulmonary medicine elective rotation.

The effect of a patient education program on emergency room use for inner-city children with asthma.

An educational program for children with asthma designed to reduce emergency room (ER) use enrolled all eligible children (n = 253 primarily low-income Black) within a health maintenance organization (HMO) who had used the hospital or ER for asthma during the pre-enrollment period and randomized them into two groups. Twenty-four of the experimental group patients had 55 ER visits and 18 of the control patients had 39 ER visits during the first 12 months post-intervention. This program did not achieve its goal.

Adjustment of caloric intake based on self-monitoring in noninsulin-dependent diabetes mellitus: development and feasibility.

It has been recommended that patients who perform self-blood glucose monitoring use the information gained from the test to alter their diabetic regimen. Skyler et al. have proposed algorithms for patients to adjust their insulin dosage when blood sugar is elevated. However, the clinical result of increasing insulin dosage may be the promotion of weight gain. We proposed that altering the regimen by decreasing caloric intake is an appropriate first approach for NIDDM patients for whom weight loss would be of considerable benefit. Results of an initial needs assessment showed that patients did not generally regard testing and adjusting therapy as important in taking care of diabetes. A recent study by Fox et al. reported similar results, showing that a large portion of patients using blood glucose self-monitoring do not make changes in their regimen when they know that their blood sugar is elevated. Consequently, we implemented a half-day seminar to instruct patients on making adjustments in their dietary regimen on the basis of results of glucose monitoring. Results suggest that our teaching methods were effective in teaching patients to follow the adjusting algorithm. Although we observed trends toward improved metabolic control and weight loss, further studies are required to document the clinical benefit of adjustment of caloric intake based on self-monitoring in diabetes.

The role of patient education in the management of childhood asthma.

Because patient behavior plays a major role in the prevention or precipitation of acute asthma attacks, patient education is an important adjunct to its medical management. A number of self-management education programs for patients with asthma recently have been developed and made available for widespread use. Many are aimed at children over the age of 6 years and their parents. They are designed for use with several types of patients in a variety of settings. Evidence of program effectiveness is of uneven quality, but what is available suggests that a number of the programs can be of significant value in reducing asthma morbidity. Self-management education programs for parents of preschool-age children and for adults with asthma are much less numerous and well developed than those for school-age children. Particular attention is given to the process by which the AIR POWER and AIR WISE programs for children were developed, since this systematic development process is generalizable to patient education programs for other age groups and health problems.

Self-management education of children with asthma: AIR WISE.

This study was conducted to test the efficacy of AIR WISE, an individually administered asthma self-management program. Subjects were paired and randomly assigned to either an experimental group (N = 7) or a control group (N = 7). The frequency of experimental group emergency visits, analyzed over a 12-month posttreatment period, was substantially less than those of the control group, supporting the hypothesis that AIR WISE is effective in high-utilizer children through improved self-management.