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Objective: To describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients' possibilities of reaching national treatment targets., Design: A Swedish national survey., Setting: Swedish PHC., Subjects: Data from 485 primary healthcare centres (PHCCs) and 91,637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006., Main Outcome Measures: Description of how patient education is arranged, HbA(1c), body mass index, cholesterol, blood pressure, and physical activity., Results: Of the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients' needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients' needs. The majority of PHCCs (96%) reported that they set individual goals (HbA(1c), blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients' possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1-5.7%. Neither individual counselling (checklist-driven or individualized to patients' needs) nor group education had an impact on patients' possibilities of reaching the targets., Conclusion: The current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients' possibilities of reaching national treatment targets.

Objective: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling., Method: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis., Findings: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance--care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control., Conclusions: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.

The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients' confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.

Objective: This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23)., Research Design and Methods: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-alpha coefficient., Results: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-alpha values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales., Conclusions: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.

Background: In his Welfare Theory of Health Nordenfelt describes health as a person's ability to fulfil vital goals in different life areas. In order to use the theory in nursing, a semi-structured interview guide was constructed including questions about which vital goals Type 2 diabetic patients have and believe are important for their own welfare in different life areas., Aim: The aim of the study was to carry out preliminary validation of the interview guide. Two hypotheses were formulated: (i) Dissatisfied or unhealthy diabetic persons score lower on health-related quality of life (HRQL) than do those classified as healthy; (ii) A person with diabetes who uses avoidance as his/her main coping strategy restructures his/her vital goals in order to avoid failure and thereby dissatisfaction increases., Methods: Interviews with 155 randomly selected Type 2 diabetic patients were conducted using the interview guide. HRQL and coping were also measured. The interview data were analysed using content analysis., Results: The results were in accordance with the health theory, i.e. a person with Type 2 diabetes may be unhealthy, but still satisfied with life as a whole. Our two hypotheses were confirmed: Dissatisfied or unhealthy subjects with Type 2 diabetes had HRQL scores in all domains but physical functioning and bodily pain that were lower than scores of those who were satisfied or healthy, and a person with Type 2 diabetes who uses avoidance as his/her main coping strategy does seem to restructure his/her vital goals to avoid failure., Conclusion: The theory-based interview guide tested in this study seemed to reflect the notion that health includes fulfilment of vital goals.

The overall aim was to gain insight into and understand how physicians and nurses view the implementation of empowerment group education (EGE) in diabetes. Prior to the study the physicians and nurses attended a 2-day empowerment workshop. Further, they had implemented the empowerment approach in two groups of patients with type II diabetes. Three to 9 months later they (five physicians and 11 nurses from six family practices) participated in focus group interviews to evaluate the implementation of the EGE. The interviews were audio-taped, transcribed and analysed using the constant comparative method. The main result showed a conflict in roles. The physicians and nurses knew their role in the traditional approach but not with respect to the empowerment approach, which they needed to grow into. At the same time as they started a new way of working, their role had changed from being an expert to being a facilitator. As experts they felt secure; as facilitators they needed support in their educational process. To implement EGE they required support both from the family practice and from a supervisor in direct connection with the EGE.

The aim was to compare self-care and perceived educational needs in adult Tanzanian and Swedish diabetic patients. One hundred and fifty Tanzanians were matched with Swedes (n=150). All 300 patients filled in questionnaires about their self-care and educational needs. The comparison indicated the Tanzanians were almost as satisfied with their self-care as the Swedes, but Tanzanians were dissatisfied with the lack of drugs and wanted more diabetes education while the Swedes were more dissatisfied with their own self-care behaviour. None of theTanzanians monitored their own blood glucose, whereas half the patients in the Swedish group did so weekly or monthly. The findings suggest that diabetes education in Tanzania should concentrate more on basic diabetes knowledge. In Sweden, however, the main points to be stressed should be life style and psychology.

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and self-perceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gender-matched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%. Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.

A controlled cross-sectional study with the aim of studying oral health in patients with type 2 diabetes was carried out in a health care district in Sweden. The study included 102 randomly sampled diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area, treated at the same Public Dental Service clinics. Oral conditions were measured at clinical and X-ray examinations. Diabetes-related variables were extracted from medical records. Diabetic patients suffered from xerostomia (dry mouth) to a significantly higher degree than non-diabetic controls did (53.5 vs. 28.4%; P=0.0003). Sites with advanced periodontitis were more frequent in the diabetic group (P=0.006) as were initial caries lesions (P=0.02). Diabetic subjects showed a greater need of periodontal treatment (P=0.05), caries prevention (P=0.002) and prosthetic corrections (P=0.004). Diabetes duration or metabolic control of the disease was not related to periodontal status. However, patients with longer duration of diabetes had more manifest caries lesions (P=0.05) as had those on insulin treatment when compared with patients on oral/diet or combined treatment (P=0.0001). The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health. Close collaboration between the patient, the primary health care and oral health professionals could be a way of improving the diabetic patient's general and oral health.