The Diabetes Educator Role in Ontario: A Provincial Perspective

Abstract

Background: As the diabetes (DM) epidemic in Canada continues to grow, the need to provide diabetes self-management education (DSME) becomes increasingly important. Research has shown that DSME can improve both physiological and behavioural outcomes in individuals with DM. Diabetes educators (DE) play an essential role in providing DSME to individuals with DM. Although considered an important role in the care of individuals with DM, the DE role is not well described in Ontario. Building a province-wide description of DEs’ role would outline the role of DE in Ontario is enacted, and suggest possible areas for improvement. The specific objectives of this study are: a) To describe the demographic characteristics of DEs in Ontario; b) To identify the structures, processes, and outcomes associated with the role of DEs; c) To identify the facilitators and barriers to providing DSME in Ontario; d) To identify the association between key characteristics of DEs (profession, education, certification, practice-setting, and DM-specific training) and the structures, processes and outcomes of this role. Methods: This cross-sectional study used an online questionnaire, the Diabetes Educator Questionnaire (DEQ). The DEQ was developed using the International Standards for Diabetes Education and Donabedian’s framework to examine the structures, processes and outcomes associated with the role of DEs. The study consisted of three sequential phases: (1) pre-testing the questionnaire in a tertiary care diabetes program, (2) pilot testing the questionnaire to a single Diabetes Educator Section (DES) chapter of the Canadian Diabetes Association (CDA), and (3) administering the DEQ to the remaining DES chapters across Ontario. The online questionnaire was created using LIME survey, an open source survey program housed at McMaster University. Data were downloaded, cleaned, and analyzed using statistical and geographical mapping software. Results: The DEQ demonstrated both face and content validity. A total of 178 out of an estimated 600 DEs across Ontario responded to the DEQ, for an overall response rate of 30%. The respondents consisted of 61 registered nurses, 94 registered dietitians, 18 pharmacists, and 4 nurse practitioners, and 1 undescribed. The majority (85%) of respondents were CDEs. Insufficient time, and organizational/management support were the two most common barriers to implementation of the role of the DE. Significant differences (p value greater than 0.05) in how DSME was provided and the use of outcomes were observed for profession, level of education, and practice setting. Limitations: With a low response rate, conclusions cannot be drawn from this study. Being an anonymous study, intra-rater reliability could not be performed. Conclusions: This study shows that the DEQ serves as a feasible tool to explore the role of DEs in Ontario, however, improved recruitment strategies are necessary before further research is performed. The study provides a foundational description of DEs across Ontario, generating possible hypotheses for future research.