Targeting vulnerable people with diabetes?

Development and test of health care education methods and tools 
Aim and purpose
A report from the Danish Health and Medicines Authority from 2011 (1) shows that people with a low or no education suffer more often from a lifestyle disease than people with a longer education. It also shows that the consequences such as mortality rate, disabilities and lowered work abilities are more frequent for this group.  Research also shows that there is a social inequality in regard to prevalence and prognosis of type2diabetes. Obesity is for example seen more frequently in people with a low education or low income.(2) Very often these people also have low literacy skill which can give them trouble reading prescription labels, following instructions or participating in patient education (3).

It therefor turns out that a serious number of vulnerable patients offered patient education do not participate or are not capable of translating what they have learned to everyday life. These findings stress the need for a development of targeted patient education for vulnerable people with diabetes.

The project aims to further develop the health educational tools from the NEED concept (NEED link) and new tools to match the needs of vulnerable people with diabetes. The project focuses on using health education methods in patient education and support for vulnerable people with diabetes.

The project will run for two years, 2013-2014. Within this period the project will:

  • identify and specify the educational needs of the target groups, both the vulnerable people with diabetes and the educators
  • develop new user-oriented and innovative education methods and tools and refine existing educational tools tailored for vulnerable people with diabetes in collaboration with the target groups
  • develop a concept for competence development for educators of vulnerable people with diabetes and educate  the  educators in the new methods and tools
  • plan and complete a feasibility test of the developed education tools and the competence development concept


Design, method and theory

In the development of education tools, we will apply Design-Thinking methods. Design-Thinking ensures a person-centred innovation approach, focusing on the challenges and needs of the target group (4).

Empirical data will be collected through workshops with vulnerable people with diabetes and their educators.

To facilitate openness and activity among participants, we will apply cultural probes throughout the workshops. We also use a semi-structured manual to guide the workshops.

Data analysis will follow the procedures for grounded theory with  coding, constant comparison, conceptualization, and discovery of categories. A minimum of two researchers will complete the data analysis, and disagreements will be resolved by constant comparison of categories and codes until they reach consensus.

Furthermore, educators will be actively involved in prototyping the education tools.

Target groups

The target group consists of vulnerable people with type 2 diabetes and their educators. The education tools and the competence concept are expected to be suitable for other patient education settings in Denmark focusing on education in chronic illness.

Expected outcomes

We expect that the tools and the competence development of educators will result in patient-centred and interactive patient education and support. We expect educators to be better equipped to educate and support vulnerable people with diabetes.

Interaction with the target group is expected to be structured in an involving and supportive way. By tailoring the education tools and improving the competences of the educators the intention is for vulnerable people with diabetes to enhance self-management skills and to improve their life with diabetes.

The Danish Diabetes Association received a grant of 1.4 million DKK from the Ministry of Health’s fund for activities aiming to reduce social inequality in treatment outcomes in people with little or no educational background.

Steno Health Promotion Center, The Danish Diabetes Association and the Region of Southern Denmark have initiated this collaborative project.

The Danish Diabetes Association holds the project management. Patient Education Research at Steno Health Promotion Center is responsible for research and development.
 The Region of Southern Denmark forms the research field and handles contact to people with diabetes and educators.

1: Sundhedsstyrelsen 2011: Ulighed i sundhed – årsager og indsatser.
2: Ministeriet for sundhed og forebyggelse. Ulighed i sundhed. Marts 2013
3: Russell L. et.all. The Spoken Knowledge in Low Literacy in Diabetes Scale A Diabetes Knowledge Scale for Vulnerable Patients The Diabetes Educator 2005 31: 215
4:  Brown. Design thinking. Harvard Business Review. June 2008.

Sidst opdateret 13-12-2016


Annemarie Varming
Diabetes Management Research