Improving knowledge skills and attitudes– a retrospective evaluation of Steno Advanced Health Care Professional Course

Background
Latest global estimates suggest that there are more than 415 million adults with diabetes. Knowledge on good diabetes care is lacking among health care professionals. The Steno advanced health care professional (HCP) course aims to improve clinical practice and patient outcomes by training and empowering health care professionals with knowledge and skills and improving their attitude to diabetes care. All the courses are developed to suit the local educational needs and challenges of the region where the training is given.
Aim
To study the success of short term Steno Advanced HCP course for non-medical health care professionals and identify cluster of topics and diverse teaching methods which are more successful in improving HCP’s attitude to diabetes care.
Method
The first two levels of the Kirkpatrick method were used to study the HCP courses conducted between 2012-2016. Five courses, one in Taiwan (2012), Iran (2016), and Vietnam (2016) and two in Turkey (2013 and 2015, with participants from Jordan, Iran, Iraq, Israel, Lebanon and Turkey), were included in this study.

All the participants completed an 'end of course' evaluation. Participant’s gain in knowledge and changes in attitudes was assessed using pre-and post-test validated instrument administered at the beginning and the end of the course. The test instrument had 2 parts, namely a multi choice questionnaire and an attitude measure. The knowledge measure was scored against the answer key. Gain in knowledge was analysed using the T-test. The attitude statements were divided in to five themes - team development, patient empowerment, team care, quality of care and management concepts and responses scored using a 5-point scale ranging from totally agree to totally disagree. Change in attitude was analyzed by Wilcoxon signed-rank test. Teaching sessions were similarly categorized. Retrospective qualitative analysis to understand the variations in the course design that led to changes in attitudes was conducted.
Results
Overall 253 participants attended the five courses. The participants were nurses (70%), diabetes educator (10%), dieticians (5%), and others (5%). Average work experience of the participants ranged from 9-12 years. The overall average for the ‘end of course’ level 1 assessment was 4.6/5. (on a scale from 1-5), wherein 1 = no value and 5 = great value. The individual evaluation scores for all the sessions were above 4, ranging between 4.1 and 4.9 (on a scale from 1-5). Gain in knowledge was significant in all courses and varied between 19% and 40%. However, not all courses showed significant change in attitudes. Significant positive change in attitude varied between 2 to 5 out of 10 statements in the five courses.
Positive changes in attitudes were associated with increased number of teaching sessions using different teaching methods (lectures and workshops) focusing on the particular theme. For example, significant change in three out of the four attitude statements on patient empowerment were seen in the Taiwan course where five sessions related to the theme (e.g. health educational tools, guided self-determination, making healthy food choices etc.) were included. Similarly, significant changes were seen in the statements focusing on team development in Iran and Vietnam, where four sessions on team development targeting communication, motivation and behavior change, were included. Change in attitude on team care was significant in Iran where more sessions focused on team care (‘how to improve adherence’, ‘why don’t the patients do as we tell them’, inter professional collaborative care practice etc.) as compared to other courses.
Discussion

Care provider attitude is an important determinant of successful diabetes case management. HCP training courses should not only focus on improving knowledge and skills but also target care provider attitude. While all courses evaluated in this study were highly valued and appreciated and significantly improved knowledge, even among care providers with almost a decade of experience, significant change in certain attitudes were seen only in courses where a particular theme was targeted through a cluster of topics and teaching methods - lectures, workshops and practice sessions.

Conclusion- To improve success of short term HCP courses, and change attitudes significantly, it is important to address themes through a cluster of topics and different teaching methods enabling the participants to understand the concepts better, internalize them and have an opportunity to practice or discuss in a workshop.

No conflict of interest