Study identifies gaps in health education needs of prediabetes patients in SG

In Singapore, primary care patients with prediabetes seldom receive education, and many of them do not consider themselves to be at risk of diabetes, as reported in a study.

“Polyclinic doctors and primary care patients have contributed to this low prevalence of education … consistent with the findings of other studies,” according to the authors.

Physicians do not often discuss prediabetes or refer patients for education owing to heavy patient load, poor understanding of the disease, or lack of skills or confidence in counselling. On the other hand, individuals with prediabetes rarely seek education due to poor awareness, lack of information on the availability of educational programmes, or unwillingness to pay or travel far to receive education. [Endocrine 2013;44:623-633; Metab Syndr Relat Disord 2011;9:231-237; Diabet Med 2016;34:14-26]

In the current analysis involving 433 adults with prediabetes, only 26 percent had ever received education regarding their condition, and 49.2 percent did not see themselves as susceptible to diabetes. [Prim Care Diabetes 2020;14:254-264]

Receipt of prediabetes education was positively associated with school education (adjusted prevalence ratios [aPRs], 1.42 and 1.45 for secondary and postsecondary, respectively), impaired glucose tolerance (aPR, 1.47), number of comorbidities (aPR, 1.08), having a family or peer with diabetes (aPR, 1.47), support to reduce diabetes risk (aPR, 1.54), and confidence to self-manage condition (aPR, 1.74 and 1.97 for moderate and high, respectively), but negatively related to age (aPR, 0.99).

In the interview, the common reasons endorsed for not receiving prediabetes education were as follows: not being referred for education by doctors, no time to receive education due to other pressing commitments like work and family, not aware of or lack of information on where they could seek education, perceived no benefits from receiving education, did not feel at risk of diabetes, and no experience of any negative consequences of prediabetes yet.

Majority of the participants wanted to receive education on healthy eating (62.3 percent) and physical activity (60.4 percent), and the most desired venue was the community center. When asked about their preferred content of health communication messages, the participants preferred that messages focused on risk and prevention of diabetes, the value of living healthy and the need to do so for their family, and avoiding the term prediabetes so to prevent labelling.

The present data underscore a need to fill the gaps in health education and communication needs of primary care patients with prediabetes in Singapore, the authors pointed out.

“To increase the take-up rate of education programmes, one strategy would be to train primary care doctors so that they could initiate conversations on prediabetes during their encounters with these patients. If this is not possible within the busy primary care setting, they should direct these patients to nurse educators, or even refer to community resources,” they said.

In line with the study participants’ preference for community-based programmes, education may be extended from the primary care setting to the community. The authors suggested that health education programmes be conducted in local community aggregate areas, where specific skills such as how to cook healthy food as well as how to exercise for the elderly and those with medical issues could also be demonstrated.

Finally, family and peer “could potentially be engaged as agents of change and the education programme be promoted as a family/peer bonding activity,” they added.

Despite the presence of limitations, the present study was one of the very few to adopt a mixed methods approach in understanding the health education and communication needs among primary care patients at high risk of diabetes, the authors said. “Although the study sample was not generalizable to all individuals with prediabetes in Singapore, the sample was largely representative of the total National Healthcare Group Polyclinic patient pool with prediabetes.”