The Perceptions and Impact of a Health Professional Mentoring Program for Multidisciplinary Diabetes Educators in Australia: A Quantitative Study

Introduction

The purpose of the study was to explore the perceptions of a health professional mentoring program for diabetes educators in an Australian context. The project aimed to add strength and knowledge of the perceptions and impact of the current ADEA mentoring program in order to further improve its design and use in the future. A broader aim of the project was to add to the body of knowledge for the development and use of cross-disciplinary health professional mentoring programs. The focus themes identified for exploration included the benefits of mentoring, barriers to effective mentoring and strategies/enablers to effective mentoring.

The benefits of mentoring have been well documented in the literature and include development and refreshment of professional skills and knowledge, networking with colleagues, feeling professionally connected, the development of confidence and leadership, and feeling empowered and satisfied from participating^2-5. Barriers include the time required to commit to a mentoring partnership, lack of organisational support, miscommunication, and mismatches between mentors and mentees^{2, 6}. Many studies have also detailed strategies to ensure the effectiveness of mentoring programs. The expectations, objectives, roles and responsibilities and timeline of a mentoring partnership should be realistic, with the commitment agreed upon by mentors and mentees^{2, 3}. A successful mentoring partnership relies on building a mutual connection based on trust, respect, flexibility and commitment and was also described as more effective if mentors and mentees mutually select each other^{2, 6, 7, 8}. The use of training and resources also enhanced the effectiveness of mentoring and varies between mentors and mentees, with formal, structured programs  shown to be most effective, due to the clear and documented expectations of roles and objectives^{2, 3, 5, 6, 9}. Overall, mentoring has been used across a wide variety of professions, for the intention of personal and professional development, through a relationship based on support, guidance and feedback⁴.

Methods

Study design

A quantitative exploratory study design was utilised to investigate the experience of the ADEA mentoring program for diabetes educators. A survey was developed by the authors to explore the perceptions and impact of the mentoring program. A literature search revealed no existing appropriate tools to measure perceptions and impact of mentoring programs or specific for use. The survey included demographic data, closed-ended questions, multiple-choice questions, and 25 statements, utilising a 5-point Likert scale. The survey was reviewed for content and face validity by five academics and five diabetes education experts. The five diabetes education experts consisted of a novice mentee, an experienced mentor, two diabetes education academics, and the Manager of Professional Services and Education from the ADEA National Office. A Content Validity Index (CVI) process was used to ensure each item / statement to be measured was relevant and clear to the topic, and the survey was amended following recommendations from the experts resulting in changes in language and the removal of suggestive wording such as leading questions. The survey was reviewed ten times with a final version entered into the online software SurveyMonkey. The survey recorded demographic data, followed by closed-ended questions, yes/no/unsure questions, and tick box responses to questions. A total of 25 positive and negative statements, utilising a 5-point Likert scale were used to measure participant responses aiming to reveal attitudes and viewpoints towards each statement.

Population and recruitment

The sample population consisted of members of the ADEA, who were currently either a mentor or mentee. In 2019, there were 2348 ADEA members across Australia, from various primary health professions, and 95 mentoring partnerships registered¹⁰. Participants were recruited nationally using convenience sampling via an email invitation sent to ADEA members. The email included an introduction of the research, benefits of the research, a plain language information statement and a link to the survey. The survey was open for a period of five weeks, with implied consent assumed on completion of the survey.

Ethical considerations

Approval to undertake the research was gained from the Federation University Australia Human Research Ethics Committee following a standard application (Approval no. A19-085). External approval was also gained from the Chief Executive Officer of the ADEA.

Data analysis

The quantitative data set collected was analysed using descriptive and inferential statistics. The survey responses collected via SurveyMonkey were exported into an Excel file and imported into SPSS, version 25¹. Data was cleaned to remove outliers and missing data from participants who failed to answer questions or respond to items in the survey. Descriptive analysis was used to summarise the demographic data of the participants, including number of mentors/mentees, age, gender, primary profession, length of time involved in the ADEA mentoring program, and number of times a participant had undertaken the role of a mentor. Independent t-tests were used to test for significant differences in responses to statements between the two independent samples, mentors and mentees¹¹. The t-testing enabled the researchers to compare the results from independent samples, utilising the mean scores on a continuous variable¹². Therefore, the independent sample t-test determined whether there was a statistically significant difference in mean scores of mentors and mentees¹². Utilising the Levene’s test for equality of variances of the two groups (mentors/ mentees), equal variances were not assumed as the p < 0.05. A statistically significant difference in mean scores of mentors and mentees was reported if the significance (2-tailed) was equal or less than 0.05¹².

Results

Of the 75 participants, 69% (n = 52) were mentors, while 31% (n = 23) were mentees, ranging in age from 20s to 69 (see Figure 1) of which 3% (n = 2) were male and 97% (n = 73) were female. The primary profession of the participants included 96% (n = 71) Registered Nurses, with the remaining 4% being an Accredited Practising Dietitian (n = 1), a Pharmacist (n = 1) and a Registered Midwife (n = 1). Most participants were from Victoria, with all states represented except for the Northern Territory and Australian Capital Territory (see Figure 2).

Figure 1: Age of Participants

Figure 2: State of participants

The length of time participants were involved in the ADEA mentoring program ranged from 6 months or less, to 11 or more years (see Figure 3). For mentors, the number of times they had mentored a diabetes educator for initial credentialling ranged from one to three times, to more than 16 times. Approximately half of the mentors, 49% (n = 25), were listed as an available mentor on the ADEA website. Many of the participants who were not listed reported that this was because they did not feel they had enough experience to mentor others.

Figure 3: Length of time participants involved in ADEA mentoring program

When asked about the perceived benefits of cross-disciplinary mentoring, participants reported the biggest benefits to be interdisciplinary collaboration (56%), developing a greater understanding of scope of practice (25%), and the opportunity for broader networking (8%). A total of 11% (n = 8) perceived there were no benefits of interdisciplinary mentoring.

When asked if they would mentor, or be mentored by a diabetes educator outside their primary discipline in the future, 49% (n = 37) reported “yes”, 23% (n = 17) said “no” and 28% (n = 21) were unsure. For those that responded “yes”, there was a focus on a greater understanding of the role and scope of practice of the different disciplines, learning from each other, and promoting interdisciplinary cooperation. For those who responded “no”, their rationale included concerns about difficulty understanding each other’s specific roles and scope of practice. The means in which mentoring partnerships were established included 35% (n = 18) through a workplace colleague, 31% (n = 16) via the ADEA website, 17% (n = 9) were recommended by a friend or colleague, 11% (n = 6) due to a previous clinical placement, and 6% (n = 3) from attending a conference or other meeting.

There were only three statements that yielded statistically different responses between mentors and mentees from the 25 Likert scale statements (Table 1, highlighted in blue). Two statements related to the ADEA resources being utilised as part of the mentoring program, and one related to support from one’s workplace to undertake the mentoring program. There was a statistically significant difference between mentors and mentees with response to the statement “The ADEA online resources were useful” (t = 2.262, p = .032). Although both neither agreed nor disagreed, mentees perceived the resources were more beneficial than mentors. Responses to the statement “The ADEA mentoring manual did not meet my learning needs”, were also statistically significant between mentors and mentees (t = 3.738, p = .001). Mentors did not perceive the manual met their learning needs, while mentees neither agreed nor disagreed. With regard to mentoring logistics, mentors disagreed with the statement “I received adequate support from my workplace to undertake the mentoring program”, while mentees neither agreed nor disagreed (t = 2.530, p = .016). Mentors perceived their workplaces as not supportive when mentoring novice diabetes educators towards credentialling, while mentees were unsure. Of the remaining 22 statements (as per Tables 2 and 3), both mentor and mentee responses were similar regarding all aspects of mentoring and the program itself.

Table 1: Inferential Statistically Significant Responses to Likert Scale Statements

Table 2: Inferential Statistical Results of Positive Likert Scale Statements

Table 3: Inferential Statistical Results of Negative Likert Scale Statements

Discussion

Barriers to effective mentoring include, the time to commit to mentoring, lack of organisational support, miscommunication, and inappropriate matching of mentors and mentees^{2, 5, 6}. Unlike previous studies which have reported time constraints as a barrier to participation in a mentoring program, participants in the current study believed it was easy to devote appropriate time to the program (see Table 3). At present the ADEA mentoring program is set to a minimum of six months, however each partnership is self-directed and the partnership may last for as long as each member deems appropriate. Participants in the current study neither agreed nor disagreed that technology helped them connect with their mentoring partner, or that face-to-face meetings was the most beneficial form of communication, which could lend itself to trialling online versions of mentoring in the future[8]. In the current study, there was a statistically significant difference between mentors and mentees with respect to organisational support, with mentors perceiving that they did not receive support and mentees being unsure.

A lack of communication and mismatch between mentors and mentees have been identified as barriers to effective mentoring². In the current study both mentors and mentees perceived their mentor or mentee to be easy to engage with. These findings could indicate that the self-selection of mentors and mentees in the ADEA mentoring program was a positive quality of the program, and supports the findings of a previous study regarding mentoring success with mutual selection of partnerships⁶.

Effective mentoring strategies include developing clear partnership objectives, defining roles and responsibilities of mentors and mentees, and the inclusion of resources and training to support participants,^{2-4, 8}. Previous studies suggest the expectations, roles, responsibilities, and objectives of a mentoring partnership should be realistic and agreed upon by both mentors and mentees at the beginning of the partnership^{2, 3}.  In the current study, both mentors and mentees were unsure of their roles and responsibilities for developing goals for participation in the ADEA mentoring program. These results are interesting, as the same participants also perceived the mentoring program met their expectations and perceived their partner’s expectations to be realistic. These results may indicate the overall strength and positive use of the program, despite participants not being clear on their roles. Previous studies also focused on the training and resources to enhance the effectiveness of mentoring programs^{2, 3, 5, 9}. In the current study there was a statistically significant difference in the perceptions of mentors and mentees regarding the ADEA online resources. Mentors in the current study agreed that the ADEA mentoring manual met their learning needs, while mentees neither agreed nor disagreed. This could indicate the need for further development of current ADEA mentoring program resources.

Both mentor and mentee participants in the study agreed that feedback was important to build confidence and should always be constructive, suggesting that the use of formal feedback could be an enabler to promote effective mentoring. Previous research has identified] the ability to give feedback as an essential skill to develop in the course of becoming a valuable mentor⁶. In the current study, a significant proportion of the participants had been involved in the ADEA mentoring program for five to ten years (24%), or more than 11 years (19%), which could suggest the experience of participants was a factor when providing constructive feedback. These results may also indicate the need for information and resources on how to give constructive feedback, especially for new mentors.

Limitations

There were recognised limitations of the current study. Missing data resulted in 23 participants being excluded from the study due to incomplete question responses which significantly reduced the sample size. Another potential limitation of the survey tool was the positive skew of the statements. While the researchers aimed to include both positive and negative statements to avoid bias, the skewed positive outlook of the survey may have altered participant interpretation of the survey. Consideration should be given whether the inclusion of matching pairs of mentors and mentees, in particular mentoring partnerships, may have yielded different findings of the study¹³. Given that over two thirds of the total number of participants were mentors, this may have impacted the validity of the study¹¹. The study also did not ask participants about whether they had taken part in an interdisciplinary mentoring relationship, only their perception of the same, which could have produced different results. In addition, the generalisability of the current study may also be impacted due to the low percentages of participants from varying disciplines.

Implications/ Recommendations

The current study highlights recommendations for the future of the ADEA mentoring program, and mentoring on a broader level. Specific to the ADEA mentoring program, existing resources should be reviewed and refined, enabling clearer guidelines for goal setting, providing and receiving constructive feedback, and role, and responsibilities within the mentoring partnership.  Further research is also proposed to assess the various requirements of cross-disciplinary mentoring and the provision of constructive feedback. Due to the evolving nature of the role and scope of diabetes educators’ practice across varying health professional backgrounds, the findings of this study into the ADEA mentoring program warrants ongoing revision to ensure the needs of all health professionals are being met.