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Implementing a structured education program for children with diabetes: lessons learnt from an integrated process

Mary Sawtell1, Liz Jamieson2, Meg Wiggins3

  • 1Social Science Research Unit , UCL Institute of Education , London , UK.

BMJ Open Diabetes Research & Care
|May 14, 2015
PubMed
Summary
This summary is machine-generated.

The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) program showed perceived benefits for families managing type 1 diabetes, but faced low uptake and high staff burden. Further program improvements are recommended.

Keywords:
EducationPediatric DiabetesRandomized Controlled TrialResearch Methodologies

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Area of Science:

  • Pediatric Endocrinology
  • Clinical Psychology
  • Health Services Research

Background:

  • Type 1 diabetes in youth requires interventions to improve glycemic control and quality of life.
  • The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured group program using psychological techniques for children with type 1 diabetes and their parents.
  • A mixed-methods process evaluation assessed CASCADE's feasibility, acceptability, fidelity, and perceived impact within a cluster randomized control trial.

Purpose of the Study:

  • To evaluate the feasibility, acceptability, fidelity, and perceived impact of the CASCADE program.
  • To identify barriers and facilitators to the uptake and delivery of CASCADE.
  • To inform future improvements for clinic-based diabetes education programs.

Main Methods:

  • A cluster randomized control trial involving 28 pediatric diabetes clinics and 362 children (aged 8-16) with type 1 diabetes (mean HbA1c ≥8.5%).
  • A mixed-methods process evaluation utilizing diverse research methods.
  • Data collection included program delivery metrics, staff feedback, and family experiences.

Main Results:

  • Only 30% of families received the full CASCADE program, with 53% attending at least one module; 68% of planned groups were delivered.
  • Staff reported burdens related to organization and mastering psychological techniques; family uptake was affected by scheduling and other commitments.
  • Attendees reported improved family relationships, knowledge, confidence, and motivation, but the trial did not significantly improve HbA1c at 12 or 24 months.

Conclusions:

  • The CASCADE program was perceived as valuable by staff and families, offering benefits in relationships and self-management knowledge.
  • Despite perceived benefits, poor uptake and high staff burden limit the program's effectiveness.
  • Recommendations focus on optimizing organization, design, and delivery to enhance the impact of CASCADE and similar future interventions.