Feasibility of diabetes peer education for Turkish type 2 diabetes patients in Dutch general practice

doi:10.1016/j.pec.2003.07.011

Patient Education and Counseling

Volume 53, Issue 3, June 2004, Pages 359-363

https://doi.org/10.1016/j.pec.2003.07.011 Get rights and content

Abstract

The feasibility of a 9-month educational diabetes programme (tailored to Turkish patients, provided by Turkish bicultural female educators) was assessed in terms of dropout rate, patient and GP satisfaction, and GP’s perceived workload. Of the 54 Turkish patients (39% males) that signed informed consent, 45 actually started the education. Dropout rate during the programme was 41% (main reason: going abroad for a long period (18%)). The individual education sessions and the consultations with the GP were highly appreciated by 87% of the patients and the group sessions by 66%. Although all nine interviewed GPs experienced a higher workload, overall appreciation of the programme was high in six GPs. Although implementation of an ethic-specific diabetes programme in general practice is well appreciated by both patients and GPs, the high dropout rate indicates that the programme needs to be more finely tuned to the individual patient.

Introduction

Type 2 diabetes mellitus is highly prevalent amongst immigrants in Western European countries [1], [2], [3]. Specific problems in this group such as language difficulties and cultural differences, as well as limited access to knowledge and low social economic status are threats to optimal diabetes management [4], [5]. Education is a cornerstone in diabetes management. Ethnic-specific education, performed by ethnic linkworkers to bridge language and cultural gaps between patient and physician has been advocated [6]. Features such as biculturalism [7], credibility of the educator [8] and tailoring [9] probably contribute to effective education in immigrant populations. However, interventions with these features are seldom carried out in immigrant populations. Moreover, data on the feasibility of such programmes are scarce [10] but necessary to target these interventions.

In The Netherlands, type 2 diabetes is more prevalent amongst the largest immigrant populations (Turks, Surinamese and Moroccans) [1] and most type 2 diabetics are exclusively treated by their GP. To support the GPs in their care for immigrant diabetics a diabetes programme within the general practice was developed for Turkish diabetics. Turkish patients were chosen as they are the largest first-generation immigrant group in The Netherlands with an accumulation of specific features: relatively low level of education, poor proficiency in the Dutch language and a rather traditional way of living.

In this study, we determine the feasibility of the implementation of a diabetes programme tailored to Turkish patients, given by peer educators in the general practice in terms of dropout rate, patient and GP satisfaction, and the perceived workload by the GP.

Section snippets

The tailor-made (peer) diabetes programme

The programme was based on three principles: peer education, tailoring and the Health Counselling Model [11]. Peer education was made operational by using educators with a Turkish background. The educators were: (1) trained medical educators, having received an informal in-house training on diabetes at the Municipal Health Service, Rotterdam Area; (2) fluent in both Turkish and Dutch language and (3) regarded as representatives of the target population. An experienced psychologist supervised

Results

In Table 1, relevant characteristics of the 54 patients (21 males, mean age 53.5 (S.D. 7.4) years and 33 females, mean age 48.9 (SD 9.9) years) that entered the study are reported.

Illiteracy (unable to read or write Turkish or Dutch) was more prevalent in women (66%) than in men (20%). Many males (56%) and females (68%) experienced difficulties in communicating with the GP (males 61%, females 71%) (detailed percentages not shown in table).

Table 2 shows the number of educational sessions

Discussion and conclusion

Our peer diabetes programme was highly appreciated by most patients and most of the participating GPs. However, the dropout rate from the programme was high (41%) and all GPs perceived an increased workload. The main reason for dropout was going abroad for a longer period (18%).

The first principle of the education was tailoring, and the educators were allowed to adjust the length of the education to the needs of the patient. Interestingly, extension of the programme beyond the planned number of

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Feasibility of diabetes peer education for Turkish type 2 diabetes patients in Dutch general practice

Abstract

Introduction

Section snippets

The tailor-made (peer) diabetes programme

Results

Discussion and conclusion

The prevalence of type 2 diabetes and gestational diabetes mellitus in an inner city multi-ethnic population

Eur. J. Epidemiol.

Diabetes mellitus among South Asian inhabitants of The Hague: high prevalence and age-specific socioeconomic gradient

Int. J. Epidemiol.

High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city: relative poverty, history, inactivity, or 21st century Europe?

Diab. Care

One-to-one teaching with pictures—flashcard health education for British Asians with diabetes

Br. J. Gen. Pract.

A pilot study of cardiovascular risk assessment in Afro-Caribbean patients attending an inner city general practice

Fam. Pract.