AimsTo identify factors that influence lack of engagement of young adults with Type 1 diabetes (aged 13-21 years) with structured diabetes education (SDE) to inform and broaden the reach of future SDE.MethodsA quantitative, cross-sectional survey was undertaken of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland and England, deemed to be representative of the wider population. Participants were asked to complete a questionnaire exploring non-attendance, along with the Diabetes Care Profile, the Diabetes Empowerment Scale (Short Form), the Diabetes Knowledge Test and the 12-item General Health Questionnaire. Demographic, health and diabetes-specific variables including HbA(1c) were also collected.ResultsThe five most commonly cited reasons for non-attendance were Had other things to do' (68.3%), No time' (62.2%), Could not get time off school/college or work' (60.8%), Learnt about diabetes from other sources' (55.5%) and Feel able to cope on own' (52.9%).ConclusionsGreater emphasis is required on communication with young people about the benefits of SDE. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes.

Aims/Objectives: Research has highlighted that men and women self-manage their diabetes differently. Greater understanding of these differences could inform educational programmes. The aim of this study was therefore to investigate how men and women diagnosed with Type 2 diabetes (≤55 years of age) self-manage their diabetes alongside their other life roles. Methods: Semi-structured individual interviews were conducted (n = 18). Recorded data were transcribed and analysed to detect emerging themes. Descriptive statistics were used to describe the sample. Results: Differences in how males and females self-manage their condition were identified. Family eating habits were more likely to change in response to male diagnosis and education, whilst females were likely to change their own diet, but minimise impact on family habits. Differences also existed within the sample regarding their understanding of their condition even after attending structured diabetes education. A key feature among this sample was the number reporting depression. Conclusion: The results indicate that education should be tailored to a greater degree to reflect the needs, capacity and circumstances of men and women. Depression may also impact upon the patients’ ability to engage with education, and may be a barrier to effective assimilation and understanding. While the results of a qualitative study cannot be generalised, there are messages for those designing diabetes education programmes, reflecting differing behaviours across genders. Further research examining needs of males and females in relation to their diabetes is essential, including the development of personalised, even gender specific education programmes.

Aim: To explore patients’ preferences when completing a questionnaire and compare preferences between younger and older patients to inform future research methodology. This research was conducted as part of a larger survey to investigate why those with diabetes declined structured diabetes education (SDE).Methods: Similar questionnaires relating to declining SDE for those with Type 1 or Type 2 diabetes were completed either electronically, via telephone, on paper and posted or via personal visit, by 177 patients in Northern Ireland. A Chi-square test for independence was carried out to determine the data collection preferences of both groups.Results: A significant association was found between age and questionnaire preference. Amongst patients with Type 1 diabetes, aged 13-23 years, 56.1% preferred to fill out their questionnaire electronically, followed by a preference for telephone questionnaires (35.1%). Postal completion of questionnaires (8.8%) was a less popular option. Those with Type 2 diabetes, aged 28-83 years preferred telephone completion (45.8%), followed closely by a preference for postal completion (43.3%), with electronic completion (10.8%) being a less popular option in this group. The numbers electing for a personal visit were too small to include in the analysis.Conclusion: Older adults had a preference for having their data collected by telephone, followed by postal methods while younger adults and adolescents preferred electronic data collection methods. The data collection phase of any survey is vital. This study has shown that taking age of the population into account when designing a survey may lead to improved response rates.

We conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or transient ischaemic attack (TIA) to all three district general hospitals in one Health and Social Care Trust in Northern Ireland from 1 January to 15 April 2008. Glucose results for each of the first 5 days of hospital admission were ascertained. We compared interventions and clinical outcome between patients who experienced hypoglycaemia (glucose < 4.0 mmol/l) in the first 5 days, and patients with higher glucose results. Our results indicated that 11 (10%) patients experienced incidents of hypoglycaemia ranging from 1.8 to 3.9 mmol/l. None of the individuals affected had received intravenous or subcutaneous insulin. Only two of the hypoglycaemic episodes involved patients with a history of diabetes mellitus. Two patients experienced episodes of hypoglycaemia on 2 or more days. Six patients experienced hypoglycaemia at the lower threshold of glucose < 3.5 mmol/l and this was not associated with a history of diabetes. A history of diabetes mellitus prompted near patient glucose testing, but among patients without diagnosed diabetes, glycaemia was under-monitored. The test that most frequently indicated hypoglycaemia was a routine electrolyte profile tested in the hospital laboratory. Patients in the first 5 days after stroke have a small risk of hypoglycaemia. There is a need for greater vigilance in the monitoring of glucose among patients admitted to hospital with stroke or TIA.

AIMS:To synthesize evidence relating to comparisons between patient-generated blood glucose records and meter memory in diabetes and to identify any predictors of agreement. METHODS:A systematic literature search was performed to identify articles comparing meter and diary records in those unaware of this assessment. RESULTS:Eleven observational studies, covering patients with Type 1, Type 2 and gestational diabetes were included spanning 1984-2009. Failure to record blood glucose measurements in the diary was the most extensive 'error', but addition of values, which were not measured, was a greater cause for concern. When present to a high degree, 'errors' lead to decreased variability in diary records compared with meter records. Allowing for a minimal amount of disagreement, just over 50% of adult diaries can be considered as 'accurate/reliable'. Disagreements were most extensive in teenagers and young adults, but the pregnant populations were only slightly better. Agreement was not related to sex, number of insulin injections or duration of monitoring. Those who were younger were more likely to have 'errors', while those who monitored more frequently had more 'accurate' diaries. CONCLUSIONS:The lack of meter-diary agreement suggests that the real reason for monitoring is not understood by many patients, raising issues about motivation, perceived need to impress healthcare providers and denial of poor control. Considering that diaries are used to inform decisions about therapy when HbA1c is raised or in pregnancy, when HbA1c is not suitable, there is significant cause for concern in relation to their clinical utility.

Diabet. Med. 29, 1108–1114 (2012)AbstractAim To evaluate the extent to which hyperglycaemia was monitored and managed among patients admitted to hospital with acute stroke and transient ischaemic attack.Methods We conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or transient ischaemic attack to all three district general hospitals in one Health and Social Care Trust in Northern Ireland from 1 January to 15 April 2008. Glucose results for each of the first 5 days of hospital admission were ascertained. We compared interventions, clinical outcome and discharge planning between patients who experienced glucose ≥ 7.8 mmol/l in the first 5 days, and patients with lower glucose results.Results The daily prevalence rate of hyperglycaemia > 7.8 mmol/l across the first 5 days ranged from 24 to 34%. A total of 41 (37%) patients experienced hyperglycaemia on at least one occasion during the first 5 days. A history of diabetes mellitus prompted near patient glucose testing, but, among patients without diagnosed diabetes, glycaemia was under‐monitored. Hyperglycaemia was a persisting trend, was under‐treated and under‐reported to general practitioners. Elevated glucose results failed to influence higher rates of fasting plasma glucose tests and BMI assessment.Conclusions There is a need for greater vigilance in the detection of hyperglycaemia and undiagnosed diabetes mellitus among patients admitted to hospital with stroke or transient ischaemic attack.

Diabetes Nurse Specialists (DNSs) are often the hub of the communications network for the entire diabetes multiprofessional health care team, patients and their families. Frequently they liaise between primary and secondary care and have a key role in the provision of a 'seamless service'. To work effectively and efficiently they need a foolproof system of documentation and communication.The aim of the study was to investigate the means by which DNSs document patient care in order to provide baseline information about ongoing record-keeping practices.The study comprised a cross-sectional survey in which data were obtained by questionnaire. All DNSs in the UK registered with the British Diabetic Association were invited to participate in the study. A 70.3% response rate was achieved (n = 545).The results indicated that manual profession-specific records were used by 65.3% of DNSs, 21.1% used shared/integrated records, 12.8% used computerized records and only 0.7% made use of patient-held records. Whilst almost all DNSs felt that a good record-keeping system was essential in providing 'seamless care' to patients, not all felt their system was efficient. Of those using a computerized system 65.7% rated it as efficient, compared with only 28.1% of those using a profession-specific system and 26.1% of those using a manual shared system.A high percentage of DNSs (65.9%) felt that the provision of 'seamless care' was hindered by communication problems with members of other professional groups.The findings from this study indicate that computers alone cannot bridge the gap between primary and secondary care, but 'seamless care' may become more of a reality with computerized record-keeping systems and participation by all members of the multidisciplinary team.

BACKGROUND:As the concept of health in Chinese people with chronic illness had not been previously explored, a scale to measure this concept in this client group was developed.OBJECTIVE:To develop and test the psychometric integrity of the Concept of Health Scale (CHS) for use with Chinese people.METHODS:Previous nursing experience and a literature review were used to inform the initial development of the CHS. It was revised following scrutiny by a panel of experts. Two studies tested the psychometric integrity of the scale. In Study One the data gathered from 80 Chinese people with a chronic illness were subjected to item analysis and exploratory factor analysis. In Study Two, with a convenience sample of 372 chronically ill Chinese people, confirmatory factor analysis was conducted.RESULTS:Instrument analysis in Study One resulted in a 34-item scale with a Cronbach alpha of 0.94. The results of an exploratory factor analysis showed that physical, psychosocial, and spiritual factors were represented by the CHS. The hypothesized model of the CHS was tested in Study Two using confirmatory factor analyses. The results of this study indicated that the concept of health was comprised of six first-order and three second-order factors.CONCLUSION:The results of this study demonstrated that Chinese people with chronic illness held a broad frame of reference in gauging the concept of health. The development of the CHS brings us one step closer to understanding how Chinese people with chronic illness regard the concept of health.

AIM OF THE STUDY:The aim of this study is to adapt an instrument suitable for assessment of the informational needs of men with prostate cancer.BACKGROUND:In recent years prostate cancer has become an important public health problem world-wide with considerable social and economic consequences. It is reported that it is the most common cancer affecting British men, with an average lifetime risk of occurrence of one in twelve.DESIGN/METHODS:Methodological research was conducted to develop an instrument to assess the informational needs of men with prostate cancer on hormonal manipulation therapy (HMT) regarding their disease and treatment. The Toronto Informational Needs Questionnaire (TINQ-BC) (Galloway et al. 1997) was modified for use with this client group and was applied to a sample of 90 men generated from three urology centres in Northern Ireland.RESULTS/FINDINGS:Construct and content validity of the instrument was established. Internal consistency reliability using Cronbach's alpha was calculated and found to be satisfactory (0.92). Using confirmatory factor analysis, factor loadings ranging from 0.37 to 0.90 were obtained and considered satisfactory. The subsections of the TINQ-BC categorized as Disease, Investigative tests, Treatment, Psychosocial and Physical needs were confirmed as individual factors. These results indicate that this instrument can be validly applied to this client group. As the instrument was initially developed in Canada and successfully used in the United Kingdom (UK), it is suggested that this instrument also has the potential for cross-cultural application. It has the potential to be used as a clinical reference instrument to assess the informational needs of this patient group. Health care professionals must be aware of the domains of information that these men perceive important so that educational interventions can be accurately and appropriately planned.

This study was undertaken to elucidate the type and range of health-promoting behaviours that Chinese people with chronic illness perform to enhance their health. Eight people with a diagnosed chronic illness were interviewed using a semi-structured interview schedule. From the perspectives of these subjects, health behaviour comprises three dimensions: physical, psychosocial and spiritual. The results of this study clarify health behaviours amongst Chinese people with a chronic illness and illustrate the important influence that culture has upon such activity. Additionally, exploring the health behaviours of these Chinese people can be used to inform and enable nurses to adjust their practices to relate more appropriately to patients’ perspectives.