Beliefs of Australian Diabetes Educators in the Care

of People with Diabetes and Intellectual Disability

Beliefs of Australian Diabetes Educators in the Care

of People with Diabetes and Intellectual Disability

J.Lehmann1. V.Stevenson2. R.Lehmann 3. 1. EdHealth Australia, Highgate, South Australia, Australia. 2. Austin Health, Diabetes Education Services, Heidelberg, Victoria, Australia. 3. Department of Genetics, University of Adelaide, South Australia, Australia.

Introduction

Discussion

Results

Method

This study captured a snapshot of self reported confidence and

beliefs of Australian DEs in the care and education of PWDID. In the

preceding 2 years, 85% of DEs had provided services to PWDID,

however their statistically significant drop in confidence in educating

PWDID, in contrast to people without ID was concerning. Of note,

77% of DEs experienced dilemmas or issues in providing this care.

The majority of DEs (66%) had a poor-fair understanding of the

disability care system which is likely to have contributed to their lack

of confidence in educating PWDID. However, the beliefs held by

DEs regarding their understanding of working with PWDID was not

as consistent (Figure 3) with 38% strongly disagreed – disagreed

with the statement and requires further investigation. It is likely that

the knowledge and skills developed by DEs can be further

enhanced to improve confidence levels in educating PWDID.

The majority of DEs (72%) felt insulin commencement was delayed

in PWDID and the issues with paid carers in administering insulin

was a contributor. (57%) It is likely their response was reflective of

the replacement of nurses with less qualified paid support workers

in the Australian disability care workforce over the past 10 years.

The majority of DEs believed paid carers can safely administer

insulin(81%) , glucagon (86%) and manage hypoglycaemia(92%)

with the development of processes to do these safely (Figure 9).

A number of questions recorded a high number of ‘unsure’

responses (Figures 4,5,8). It is likely this is reflective of the lack of

knowledge and experience of the DEs in the care and education of

PWDID in Australia. This was also reflected in their lower

confidence levels. Further research is required to understand how

DEs can be better supported in their diabetes care and education of

PWDID and their paid carers. Given their poorer health outcomes

attention is also required to the development of low literacy

education and support strategies and support material.

jayne@edhealthaustralia.com.au

References:

1.Australian Institute of Health and Welfare 2010 Health of Australians with Disability: Health Status and Risk Factors Bulletin no. 83.

Het N

Conclusion DEs reported statistically poorer confidence levels in the care and

education of PWDID. This, together with their poor understanding of

the disability care system, identified possible contributors to the

poorer health outcomes experienced by PWDID. DEs believed a

process to safely administer insulin and manage hypoglycaemia

can be designed to prevent insulin delay in PWDID. The

development of an education and skills evaluation process is

required for DEs and paid carers to support improved health

outcomes in PWDID. These study results are likely to be similar in

other countries.

People with an intellectual disability (ID) comprise 2-3% of the

general population. An Australian Institute of Health and

Welfare report (2010) identified people with severe or profound

disability were more likely to have diabetes or an elevated

glucose level before the age of 25 compared to the general

population (23% vs. 7%)1. People with diabetes and

intellectual disability (PWDID) experience poorer health

outcomes than those without disability.1 The contributing

factors to these poorer outcomes need to be identified to

create evidence based approaches to improve health of

PWDID.

A questionnaire consisting of yes/no, tick-a-box, Likert scales

and free writing options were administered to DEs at a national

diabetes and disability workshop in 2012.

Quantitative and qualitative data was collected on the

experience of DE participants with PWDID and their beliefs

about the role of paid carers in insulin therapy.

• 66% identified they had a poor to fair understanding of

the disability care system in their state (Figure 2)

• However, only 38% strongly disagreed to disagreed with

the statement: “I have little understanding of working with

PWDID which makes it difficult for me to help PWDID”.

(Figure 3)

Aim

To explore self reported confidence and

beliefs of Australian diabetes educators

(DEs) in the care of PWDID.

• 53 respondents (100% response rate)

• DEs represented all Australian states

• 32 (60%) Credentialled DEs.

• Mean experience - 8.8 yrs (range 0-32yrs)

• DE professional background: Nurse – 92%, Dietitian - 2%

Pharmacist - 2% Unknown professional background - 4%

• 85% DEs provided services to PWDID in past 2 years

• 77% faced dilemmas or issues providing this care.

Insulin Therapy in PWDID

• 72% of DEs believed insulin therapy is delayed in

PWDID (Figure 4)

• 57% believed issues related to using paid carer’s to

administer insulin contributed to this delay but an

additional 37% were unsure (Figures 5).

Figure 4. Do you believe insulin therapy is delayed in PWDID? (n = 50)

Figure 5. Do you believe insulin therapy is delayed in PWDID due to the issues related to using paid carers to administer insulin? (n = 51)

Figure 1. I feel very confident to address the diabetes care and education needs of people ...

Likert scale: 1=strongly disagree, 2=disagree, 3=unsure, 4=agree, 5=strongly agree. Results are expressed as the mean ± SEM for each group (n = 47-50). **** = p<0.0001 in Student’s t-test

Figure 3. I have little understanding of working with PWDID which makes it difficult for me to help PWDID. (n = 50)

Figure 2: Participants’ current understanding of the disability care system. (n = 50)

Diabetes Care and Education of PWDID by DEsRole of Paid Carers in Diabetes Care of PWDID

Figure 6. Do you believe paid carers should be able to assist PWDID to administer their insulin? (n = 50)

Figure 8. Do you believe paid carers should be able to administer insulin to PWDID? (n = 51)

Figure 7. Do you believe paid carers should be able to administer glucagon to PWDID? (n = 50)

• The level of DE confidence in the education of PWDID was significantly lower than that of people without intellectual disability (Figure 1).

Demographics

Figure 9. Do you believe a process can be designed for paid carers to... (n = 51)

****

• 86% of DEs believed paid carers should be able to assist people to

administer insulin (Figure 6) and administer glucagon (Figure 7).

• 61% believed paid carers should be able to administer insulin, with

24% unsure.