Evaluation of two approaches to educating elementary schoolteachers about insulin-dependent diabetes mellitus

Implementation of School Diabetes Care in the United States: A Scoping Review

Diabetes management at school demands close collaboration of multiple stakeholders, including students with diabetes and parents, school nurses, teachers/staff, and local health care providers. This scoping review identified and synthesized evidence concerning factors that contributed to the quality and effectiveness of diabetes care implementation in U.S. K-12 schools. Forty-six studies met the eligibility criteria and were included. Five common factors emerged surrounding training and experiences, communications, parent engagement, resource allocations, and school environment. Complex interactions between multiple stakeholders jointly determined the quality of school diabetes care. A conceptual model was established to elucidate the complex interactions between multiple stakeholders and the relevant facilitators and barriers. Future research should improve sample representativeness, contrast school diabetes care practices to the national guidelines, and assess the impact of the social, economic, and political environment at federal, state, local/district levels on school diabetes care implementation.

Systematic review of publicity interventions to increase awareness amongst healthcare professionals and the public to promote earlier diagnosis of type 1 diabetes in children and young people

BACKGROUND

Children with new onset type 1 diabetes (T1D) are at risk of developing the life-threatening condition ketoacidosis if they have a delayed diagnosis. The rate of children presenting in ketoacidosis remains high in a number of countries worldwide. To ensure interventions to raise awareness of symptoms are effective a systematic review was conducted to evaluate previous publicity campaigns.

METHODS

A range of databases was searched using search terms relating to T1D, publicity campaigns, and symptom awareness. Identified articles were checked against the inclusion criteria, ensuring interventions were designed to target individuals prior to diagnosis of T1D. Papers were independently assessed under the criteria specified within the Critical Appraisal Skills Programme checklist.

RESULTS

The initial search retrieved 1537 papers and following screening 20 were identified for full consideration. Thirteen did not meet the inclusion criteria, leaving 7 to be assessed. Of these 7, 2 observational case-control studies reported a reduction in the rate of ketoacidosis following a publicity campaign using posters and providing glucose testing equipment to primary healthcare professionals. Four observational cohort studies, utilized posters, and media campaigns; 2 reported a reduction in the rate of ketoacidosis and 2 reported no difference following their interventions. A feasibility study, not designed to evaluate effectiveness, reported some anecdotal evidence of a more timely diagnosis.

CONCLUSION

Due to the methodological limitations of the studies identified, it is not possible to make a definitive conclusion on the effectiveness of the interventions reported.

Assessment of the knowledge of diabetes mellitus among school teachers within the scope of the managing diabetes at school program

OBJECTIVE

Training teachers and education professionals on diabetes is crucial for full-time monitoring of diabetic children in schools. The objective of this study was to assess the knowledge on diabetes in a group of school teachers in Turkey.

METHODS

Between November 2010 and November 2011, 1054 teachers from three regions of Ankara were given a questionnaire to assess their knowledge on diabetes. The mean age of the group (27% males, 73% females) was 38.8±8 years. 61.7% of the participants were class teachers, 23.3% were school counselors, and the rest were physical education teachers and administrators.

RESULTS

A fair percentage (47.6%) of the participants had a moderate knowledge level on diabetes and 32.4% expressed a lower level of knowledge. A large proportion (94%) gave an accurate definition of diabetes. Of the total group of 1054 teachers, 625 were aware that blood glucose level might decrease in diabetic children during follow-up. Also, 75% believed that diabetic children were eligible for physical education classes. 52.8% of these teachers had no diabetic child in their classes and teachers with a diabetic patient in their family had better knowledge of diabetes compared to their counterparts.

CONCLUSIONS

Our study results indicate that school teachers have limited knowledge on diabetes. We believe that their knowledge levels can be improved by widespread training programs.

Evaluation of the impact of a diabetes education curriculum for school personnel on disease knowledge and confidence in caring for students

BACKGROUND

School personnel may lack knowledge of diabetes and be unprepared to address the needs of students with type 1 diabetes. This project evaluated the effectiveness of a type 1 diabetes education program for school personnel on increasing knowledge of diabetes and confidence in caring for students with diabetes.

METHODS

Two types of diabetes education programs were created for school personnel. The basic program provided a 60-minute overview of diabetes. The expanded program, intended for volunteer health aides, provided participants with a more in-depth overview of diabetes during a 180-minute session, including demonstrations of how to assist students with insulin injections. Instruments were created to assess changes in diabetes-related knowledge and confidence in caring for students. Separate knowledge instruments were created for the basic and expanded programs. Knowledge instruments were administered before and after delivery of the education programs to both groups. Confidence instruments were administered before and after for persons completing the expanded program.

RESULTS

A total of 81 school personnel participated in the basic (N = 44) or expanded programs (N = 37). Overall knowledge regarding diabetes significantly increased in both the basic and expanded programs from baseline (p < .001). Confidence in caring for students with diabetes also increased from pretest to posttest, both for overall confidence and each individual item (p < .001).

CONCLUSIONS

Educational programs offered for school personnel can lead to increased knowledge and increased confidence in caring for students with diabetes, which may assist school personnel in addressing the needs of students with diabetes.

A pilot study of school counselor's preparedness to serve students with diabetes: relationship to self-reported diabetes training

This cross-sectional, observational pilot study investigated the knowledge, attitudes, and awareness of 132 school counselors regarding students with diabetes. Respondents were primarily white, female, with a master's degree, aged 42 years, and with 10 years of school counseling experience. Most counselors worked at large, public, suburban, and high schools. A majority reported that there were children with diabetes in their schools, and 40% had worked directly with several students with diabetes. However, most indicated that they had received no specific training about diabetes. On a standardized measure of school personnel knowledge of diabetes, school counselors showed only a basic level of practical diabetes knowledge that is insufficient to provide effective support for diabetic students. Relative to counselors who reported no diabetes training, those who reported diabetes training showed more knowledge of diabetes and its management in schoolchildren. On a standardized measure of the psychosocial impact of diabetes, those who reported training also endorsed attitudes that indicated better appreciation of the psychosocial impact of living with diabetes. Educational attainment and number of students with diabetes served in the past was not related to knowledge or attitudes. Awareness of recommended accommodations, educational planning, problems with school personnel, and risk for psychological disturbance among diabetic students was limited. These findings suggest that school counselors are not well prepared to support diabetic students and that training may help prepare them. Practical suggestions for school counselors' care of diabetic students are offered.

Brief report: glycemic control, quality of life, and school experiences among students with diabetes

OBJECTIVE

To investigate the relationships among perceived school experiences, diabetes control, and quality of life (QOL) in children with diabetes.

METHODS

Fifty-eight children with type 1 diabetes and their parents participated. The typical child was 12 years old, had diabetes for 5 years, and attended public, suburban, middle/junior high schools with 300-500 students.

RESULTS

Children whose parents reported that school personnel received diabetes training showed significantly better diabetes control than those who reported untrained school personnel. Children who reported their classmates received diabetes training had significantly better QOL than those who reported untrained classmates. Children who reported greater flexibility in performing diabetes care tasks at school had significantly better diabetes control than children who reported less flexibility.

CONCLUSIONS

Students with diabetes continue to face challenges at school. Training staff and classmates and allowing students the maximum appropriate flexibility in diabetes care appears beneficial for disease control and QOL.

Improving students' diabetes management through school-based diabetes care

INTRODUCTION

The purpose of this pilot study was to conduct periodic diabetes care visits in school, with the goal of promoting optimal management of diabetes for high-risk youth.

METHOD

A convenience sample of 27 students receiving care at a university-affiliated children's diabetes center and enrolled in a large urban school district received the diabetes visit intervention. Intervention effect was measured by parent survey of home/school diabetes management practices, the Self-Efficacy for Diabetes Tool, and a diabetes care-provider survey of subjects' usual care, management competence, and glycemic control.

RESULTS

The frequency of diabetes care office visits, insulin adjustment, and home and school blood sugar monitoring all increased. The percentage of children receiving insulin in school doubled. Pre-intervention to post-intervention changes in glycemic control and student self-efficacy did not reach statistical significance. The response to the program was universally positive.

DISCUSSION

This study demonstrated that diabetes care visits in school are feasible and not disruptive to the students' educational program. The visits improved diabetes management at home and at school. School nurses' knowledge about diabetes and confidence in diabetes management was improved through a role-modeling approach.

A systematic literature review of the effectiveness of diabetes education of school personnel

PURPOSE

This paper describes current knowledge levels of school personnel about diabetes, discusses the findings of a systematic review of the literature on the effectiveness of diabetes educational interventions for school personnel, and presents recommendations for future research.

METHODS

English language literature published between January 1966 and May 2001 regarding the effectiveness of diabetes education of school personnel was systematically reviewed using multiple electronic databases.

RESULTS

Four studies that examined the effectiveness of diabetes education of school personnel were identified. One study demonstrated improvement in teacher knowledge of treatment, another reported significant improvement in comprehensive knowledge scores, and a third study demonstrated significant knowledge deficits across 4 measures of teacher knowledge about diabetes. A fourth study demonstrated a decrease in the cumulative frequency of diabetic ketoacidosis.

CONCLUSIONS

The literature regarding the effectiveness of diabetes education of school personnel is scant, the methodology is inadequate, the results are mixed, and the focus is on a narrow range of outcomes. Further research is needed to define effective interventions for improving the health and quality of life of school-age children and adolescents with diabetes.

Computer-based remote diabetes education for school personnel

Teachers are expected to respond quickly and accurately to any diabetes incident that may occur to children in the school setting. Access to diabetes information is crucial for student safety, health, academic achievement, and social competence. This paper describes a technique to provide Web-based diabetes information using computer audio and video to enrich a text-based training experience. Two groups of teachers were presented with diabetes training material via either paper or a Web-based computer system. Both groups were then evaluated for diabetes knowledge and satisfaction. Subjects using the Web-based system had significantly (t = 2.22; p < 0.033) higher knowledge scores (72.5% versus 66.4% correct) and were significantly (t = 3.9; p < 0.001) more satisfied with the training session (4.2 versus 3.1 on a five-point scale) than subjects who used paper documents traditionally used for teacher training. With the advantages in learning and the reduced cost of a Web-based system, diabetes distance education is a viable and desirable alternative to paper-based diabetes education.

Children with chronic conditions: educators' views

The purpose of this qualitative, exploratory study was to identify the concerns and resource needs of educators for effectively teaching children with chronic health conditions, Semistructured audiotaped telephone interviews were conducted with 23 teachers and six principals from urban and rural public schools, grades K-12. The interview included questions in four areas: (a) experiences with children with chronic health conditions, (b) concerns in providing educational services to these children, (c) resources used by educators, and (d) recommendations regarding how information and services can best be provided to educators. The most common concerns were unanticipated medical emergencies and increased absence rates. The major resource for these educators was the school nurse. Educators preferred information specific to a child in their class, provided to them by the school nurse. Results suggest that interventions for teachers are more likely to be effective when they are coordinated with the school nurse and focus on the impact of the condition on a child's ability to function in the classroom. Subsequent research is necessitated to determine effective strategies for specialty nurses to aid school nurses in providing optimum care for these children.

A cystic fibrosis handbook for teachers

The purposes of this project were to (1) develop a handbook on cystic fibrosis for elementary school teachers and to (2) pilot this handbook with a group of teachers and school nurses. The project used a descriptive survey design in which parents, teachers, and school nurses of 14 elementary-age children with cystic fibrosis were recruited from one cystic fibrosis clinic. Interest in using the handbook with their child's teachers was elicited from parents; also, interest in using the handbook was obtained by open-ended questions in a mailed survey sent to teachers and school nurses. Levels of teacher and school nurse knowledge were measured with a true/false pretest and posttest instrument. All parents expressed a desire to use the handbook with their child's teachers. Sixty-seven percent of the teachers and 89% of the school nurses returned the survey, and all endorsed the use of the handbook in their classrooms or schools. Comparison of the pretest and posttest scores from the teachers revealed an increase in teachers' knowledge. Scores on pretest and posttest measures from school nurses were high at each testing time. Results support the use of a printed handbook to promote knowledge of cystic fibrosis in teachers and to support communication among nurses, parents, and teachers.

The Effectiveness of Parents Teaching Elementary School Teachers About Diabetes Mellitus

A program to teach parents how to instruct elementary school teachers about children with diabetes mellitus was evaluated using a 14-point questionnaire prior to intervention and 6 to 8 weeks after intervention. There was a significant improvement in many aspects of the teacher's knowledge of diabetes, although a few basic concepts remained unclear. We feel that refining the presentation and repeating the program as teachers encounter more children with diabetes will provide effective basic diabetes education to the elementary school teacher.