Volume 24, Number 4 - December 2021

OzDAFNE delivers positive participant experiences

By
Margaret Whillier,

Bach Health Science (Nursing), Grad Cert Diab Mgt and Edu, RN CDE

CNC, Royal Brisbane & Women’s Hospital

Margaret is a Registered Nurse, Credentialled Diabetes Educator and accredited OzDAFNE facilitator working at Royal Brisbane and Women’s Hospital interested in promoting the OzDAFNE program to people living with type 1 diabetes and to health professionals involved in their care.

Email: margaret.whillier@health.qld.gov.au

Jane Musial and

BSc, Grad Dip Nutrition and Dietetics

Jane is an Advanced Accredited Practising Dietitian with over 25 years’ experience and an Accredited DAFNE Facilitator with over 10 years’ experience delivering DAFNE. She is passionate about delivering patient centred care to people with diabetes and investigating innovative models of care to meet the increasing demand for diabetes services.

Dr Helen MacLaughlin

BSc (Hons); BHlthSc (Nut&Diet) (Hons); PhD

Advanced Clinician Researcher and Senior Lecturer, Royal Brisbane and Women’s Hospital and QUT

Helen is a clinician researcher with a joint role across clinical healthcare and academia. Her research investigates nutrition interventions in chronic disease across a range of outcomes.

Introduction

The participant experience of OzDAFNE (Dose Adjustment For Normal Eating) was recently evaluated at Royal Brisbane and Women’s Hospital (RBWH). This involved use of standardised evaluations that were completed by participants at the end of each OzDAFNE course and review session, and an additional survey to identify enablers and barriers to attendance at follow up. The aims of this project were to examine OzDAFNE participant feedback to determine if OzDAFNE results in positive participant reported outcomes and experiences, improves quality of life, and to identify areas for improvement. Findings were recently published in Diabetes Research and Clinical Practice. 1 Following is a summary of some of the key findings from the program evaluation.

Confidence in managing diabetes significantly improved following completion of the OzDAFNE course. Before the course, most participants stated they were ‘a little confident’ (48%) and by completion of the course 96% were either ‘very confident’ (45%) or ‘confident’ (51%) to self-manage their diabetes. Figure 1 displays participants’ comments provided at the end of the OzDAFNE course.  Most participants (97%) reported that they were still implementing the OzDAFNE principles at the 12-month review. PAID (Problem Areas In Diabetes) scores were measured before the course and 12 months post course.  The average score reduced from 25 to 15 (p<0.001) reflecting a clinically and statistically significant reduction in diabetes-related distress.

Topics most often identified to be of interest by participants were carbohydrate counting, insulin adjustment, exercise, and technology. Most participants reported the learning activities and topics in OzDAFNE were helpful which indicates that the curriculum remains relevant. 

The facilitators skills were highly rated by the participants in the following areas:

  • knew a lot about diabetes management
  • approachable and helpful
  • well organised
  • presented the information well
  • good communication skills
  • helped create interaction between group members.  

Participant feedback highlighted the importance of the group experience. They enjoyed meeting others with type 1 diabetes(T1D) and comments included ‘it’s a wonderful program’, ‘I feel so much more confident moving ahead with my diabetes management. I wish I had known about DAFNE sooner’ and it’s ‘great to catch up with the group’.

Following this review of the feedback, RBWH now offers choice and flexibility with one-on-one and group sessions on the topics participants reported as most relevant and useful. This includes individualised exercise plans using OzDAFNE principles as well as psychologist-led sessions on coping and resilience. Carbohydrate counting workshops are also available for all people with diabetes and OzDAFNE graduates have found this useful as a refresher.

Prior research has confirmed that DAFNE improves clinical outcomes in the areas of glycaemic management, severe hypoglycaemia and quality of life2 and that it is cost effective3. Our study demonstrates positive participant reported outcomes and experiences that adds to the established benefit of structured group education for all people living with T1DM.

Conclusion

This project highlights the importance of

  • offering group and individual education for diabetes self-management education 
  • standardising education provided through a structured format to replicate the positive experience reported by OzDAFNE participants.
  • collecting, evaluating, and reporting the participant reported outcomes 
  • increasing awareness of the OzDAFNE program among people with diabetes and health professionals
  • increasing the number of diabetes services that offer OzDAFNE

The NDSS provides support for Diabetes Victoria to coordinate the OzDAFNE program in Australia. Health professionals must complete DAFNE Educator training to become an accredited OzDAFNE facilitator and there is a process for a facility to become an accredited OzDAFNE centre. For further information contact the OzDAFNE team via email OzDAFNE@diabetesvic.org.au or phone on 03 9667 1719.

Acknowledgements

We acknowledge Heike Krausse for her work in the organisation and facilitation of the course at RBWH, Eileen Collins and the OzDAFNE team at Diabetes Victoria for their contribution to the delivery of the program and to all the OzDAFNE participants who completed the evaluations.

References

1.

Whillier, M., Musial, J., & MacLaughlin, H.L. (2021, 2021/11/01/). Evaluation of patient experience post structured education for diabetes self management (Dose Adjustment For Normal Eating-OzDAFNE). Diabetes Research and Clinical Practice, 181, 109065

2.

DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002;325 doi: 10.1136/ bmj.325.7367.746

3.

Heller S, Lawton J, Amiel S, Cooke D, Mansell P, Brennan A, et al. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes. Programme Grants for Applied Research 2014;2(5) doi: https://doi.org/10.3310/pgfar02050.

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