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Av. Diabetol. 2008;24(6):443-452

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Patient education programmes and decision aids - evaluation of complex interventions

Revisión - Vol.24 N.6  noviembre-diciembre 2008
M. Lenz1, A. Steckelberg2, I. Mühlhauser3

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Patients have the right to make informed decisions on treatment goals and treatment regimens and also to be provided with reliable information necessary for decision-making. Evidence-based medicine explicitly integrates patients” values and preferences in treatment decisions. Both are regarded as crucial to increase both the patients” quality of care and independence. Education programmes or patient decision aids are complex interventions, typically comprising separate components acting interdependently (e.g. content, structure, and media of an education programme). They are heterogeneous in their goals, methods and target populations. Development and evaluation of complex interventions are sophisticated processes requiring both qualitative and quantitative methods. In a previous review we showed that common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. Patient education programmes were used as an example. The present review outlines present developments in patient education and shared decision making in diabetes care. It also comprises an update of the previous review. Methodological challenges of the development and evaluation of complex interventions are discussed. Methods of current systematic reviews do still not meet the challenges to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary. Information necessary for the evaluation of such programmes is difficult or impossible to identify. In conclusion we propose to establish a scientific network and database, which supports scientific exchange and systematic tagging of self-management programmes, patient education programmes and patient decision aids.


Correspondencia: M. Lenz. Unit of Health Sciences and Education. University of Hamburg.
Martin-Luther-King Platz, 6. 20146 Hamburg (Germany). E-mail: matthias.lenz@

Palabras clave

education hipertensión self-management systematic reviews


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