Patient education and compliance in non-insulin dependent diabetes mellitus.

This prospective study investigated many compliance-related aspects involving a population of Type II (non-insulin-dependent) diabetics, who attended the out-patients' clinic of a District General hospital. The investigations were undertaken from both qualitative and quantitative perspectives; activities within the clinic were observed and knowledge levels concerning diabetes mellitus were measured. A teaching programme was constructed, drawing on general educational principles; each stage was subjected to analysis and evaluation. Information, teaching and counselling skills were incorporated and a quality assurance model described. Two groups of subjects - one diagnosed less than one year (n=20), the other diagnosed more than one year (n=18) - were entered into a teaching programme; weight change was chosen as the study variable. Three interventions were planned for each subject. No statistically significant differences were found between the study groups and an historical control group, but clinically significant trends towards the target weight were recorded. Following the intervention study, a clinic-specific video was made, which was positively evaluated by subjects after it was viewed in their own homes. An innovative method of analysis was applied to health belief attributes, including vulnerability and social support-dynamic concept analysis (Kontiainen, 1973) - and models were constructed to determine whether there were common patterns of interview response from which prediction of compliance with clinical advice could be deduced. From the analysis it was concluded that computerised models could be constructed, which would be used in the clinic setting to predict, and subsequently monitor and guide, the behaviour required of individuals with NIDDM. The home viewing of clinic-specific videos would provide an adjunct to effective management through the dissemination of information outside the immediate physician-patient interaction. The main aim of Type II diabetes management is control of body weight. A means of depicting movement out of the obesity grading (Garrow and Webster, 1985) was devised, which could be utilised in a collaborative way by the health care professional and the diabetic person. From this longitudinal study it was concluded that the unique educational needs of individuals must be met by a range of inter-linked skills, methods and materials, if a solution to the non-compliance problem is to be found