Changes in Knowledge, Beliefs, and Behaviors Following a Remote Diabetic Education Session Among Adults Living with Diabetes in a Rural Community

Abstract

Introduction: The incidence of Type 2 diabetes has been a rising concern for Americans since 1994. According to the CDC, in the last 20 years, the number of adults diagnosed with diabetes has more than doubled as the American population has aged and become more overweight or obese. Health services are struggling with the morbidity, mortality, and cost associated with the complications of type 2 diabetes. Diabetes Self-Management Education and Support (DSMES) services have been shown to have a positive impact. United Health Services (UHS) in New York State offers in-person diabetic teaching classes in the form of a DSMES service. To date, there is no official educational program for patients unable to attend in-person diabetic teaching classes within the UHS hospital system. The purpose of this study is to evaluate any changes in knowledge, behaviors, and beliefs of a rural population after have completed a remote diabetes education session to help identify if patients would benefit from a formal remote education class. Methods: This study was conducted remotely in February 2022 using patients from the UHS database. The total number of rural participants was 4. Participant knowledge was evaluated by comparing scores on a pre-test and post-test. A Wilcoxon signed-rank test was used for all statistical analysis as neither of the data being assessed had normality. Qualitative data were thematically examined. Results: The most common theme for barriers related to exercise and dietary change were "work" and "physical limitation". Seven of the 14 questions included in the questionnaire were assessed for statistical significance and despite seeing some data shifts; the diabetes education intervention did not produce a statistically significant change in test scores (Z= -1.342, p = .180). BMI and HbA1c were also tested for statistical significance. Participants appeared to have lost weight between the time of the needs assessment and the intervention as the mean BMI measurement from 2022 is less than the mean BMI from 2021. Although this may seem favorable, there was no significant change in BMI from when the needs assessment was conducted in October, 2021 to the completion of the education intervention in February, 2022 (p = .854). Participants had a reduction in their HbA1c after starting this study as the minimum value for HbA1c is lower in 2022 when compared to data in 2021. Again, despite this observation, there was no significant difference in average blood sugar measurement between 2021 and 2022. Conclusion: This study showed that the diabetic education intervention conducted over the telephone did not elicit a statically significant change in test scores, weight, or HbA1c among the rural participants with type 2 diabetes. Despite observing some data shifts the sample size was simply too small to show any significant change. Although this study did not use sophisticated technology to conduct interviews and deliver education, it opened up the opportunity to possibly introduce a more enhanced way of communication, especially for those unable to attend in-person diabetes teaching classes.