Education Encourages Health-Seeking Behavior for Diabetics

An educational program is effective to encourage health-seeking behavior for infections in patients with type 2 diabetes mellitus, according to the results of a randomized controlled trial.

“Common infections in these patients may be more difficult to treat, often recur and even require hospitalization and result in increased mortality,” write Leonie M.A.J. Venmans, PhD, from University Medical Center Utrecht in the Netherlands, and colleagues. “There are only few data about the link between health-seeking behavior and morbidity in people with DM [diabetes mellitus]. We assume that delay in health-seeking behavior will increase the risk of complicated infections.”

This study aimed to evaluate the short-term effects of an educational program on determinants of self-reported health-seeking behavior for infections of the urinary tract (UTIs) and lower respiratory tract (LRTIs) in 124 patients with aged 44 to 85 years with type 2 diabetes. Participants randomized to the intervention took part in a multifaceted educational program including an interactive meeting (attended by 68% of participants), receipt of a leaflet, access to a Web site, and a consultation with the diabetes care provider. Based on findings from a previous focus group and questionnaire study, the program focused on specific patient needs.

The main endpoint was an indicator of health-seeking behavior for UTIs and LRTIs, measured with questionnaires at baseline and after 5 months. Health-seeking behavior was defined as the proportion of participants with a positive score on at least 7 of 9 determinants (6 from the Health Belief Model and 3 additional domains of knowledge, need for information, and intent).

Outcome data were complete for 468 patients in the intervention group and 472 patients in the control group. At baseline, 28% of participants in the intervention group had a positive score on 7 of the 9 determinants, as did 27% from the control group. After exposure to the study intervention, these percentages were 53% and 32%, respectively (P < .001).

“Our educational program positively influenced determinants of health-seeking behavior for common infections in patients with DM2 [diabetes mellitus type 2],” the study authors write. “We believe that this program is a first step in changing the perception of DM2 patients. Small changes may have a considerable effect on a larger scale.”

Limitations of the study include short duration of follow-up, suboptimal use of newsletter and Web site, insufficient number of observations of serious complications to permit subgroup analysis, use of self-reported measures, and concerns about the Hawthorne effect.

“Results from this study suggest that patients and practitioners should discuss infections during regular check-ups,” the authors conclude. “Materials (such as leaflets) could be used to increase the implementation of the program in daily practice. Diabetes care providers could instruct people with DM2 to contact the medical practice when symptoms occur.”

Practice Pearls

• A program for improving health-seeking behavior for UTIs and LRTIs in patients with type 2 diabetes consists of an invitation to participate in a meeting, an interactive meeting, a mailed patient information leaflet, a consultation with a diabetes care provider, and a Web site and newsletter.
• Use of the program is associated with improved health determinants of health-seeking behavior and knowledge of UTIs and LRTIs, with a greater effect of increased visits to practitioners on men vs women.

Diabetes Care. Published online December 4, 2007.