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Chronic conditions and their management have become a major global public health problem which poses a serious challenge for both health care systems and affected individuals. Type 2 diabetes is one such condition affecting almost 200 million people around the world, a number that is expected to double by 2020. As with most chronic conditions its management requires significant and permanent changes in people’s daily life practices as well as a strict medication regimen. Recent research demonstrates that it is possible to control the complications of diabetes, and even to prevent its development in predisposed individuals by following recommended treatments. Yet studies show that only 2% of people living with diabetes heed their treating team’s advice. This signals a serious discordance between scientifically generated information and its place in the daily lives of people living with diabetes. This study sought to discover how to change the factors that prevent people with type 2 diabetes from following their recommended treatments. Firstly a participant observation process in four diabetes education centres was used to define the characteristics of the context in which people with diabetes and their treating teams interacted. This was followed by a nine-month participatory action process in two of the four centres in which participants defined the problematic areas in the management of their diabetes and devised plans to tackle these problems. They then attempted to implement these plans while exploring how and why their plans did or did not work. The findings indicate that the decision to follow recommended treatments is far from being a matter of individual choice. Rather it is heavily influenced by a complex interaction of numerous factors that people with diabetes have limited power to change. This study reveals that the management of chronic conditions such as diabetes could be enhanced where operational and practical knowledge about the condition is provided to people living with the disorder by health care providers responsive to patients’ perspectives, and where patients, providers and policy-makers recognise that health is a resource constructed in the wider social context, whose every element needs to be harnessed in encouraging people to make healthier life decisions.

ÖZET Hasta eğitimi diyabetin kontrolü konusunda diyet ve medikal tedavi kadar önemli bir bileşen olarak kabul edilmektedir. Diyabetli hastaların hayatlarını sağlıklı bir şekilde sürdürebilmelerini sağlamak diyabeti tedavi edecek ekibin tıbbi bilgisi kadar iletişim becerilerine de dayanmaktadır. Ekim'97-Ağustos'98 tarihleri arasında SB Beyoğlu Hastanesi'nin Dahiliye Polikliniği'nde yürütülen bu araştırma; insüline bağlı olmayan tip II diyabet hastalarının diyabet konusundaki bilgi düzeylerini belirlemek ve hasta eğitiminin bilgi düzeyi ve hastalık seyri üzerine etkisini değerlendirmek amacıyla gerçekleştirilmiştir. Araştırmaya katılan 150 hastanın, yazılı onam alındıktan sonra, açlık kan şekeri, serum kolesterolü, sistolik ve diyastolik kan basıncı, vücut kitle indeksi (VKİ) ve HbAlc değerleri ölçülmüş ve başlangıç değerleri olarak kaydedilmiştir. Araştırmaya katılan hastaların hepsine 15 'er kişilik gruplar halinde diyabetle ilgili bir hasta eğitim programı uygulanmıştır. Hastaların eğitim öncesi ve sonrası bilgi düzeyleri, eğitimin içeriğine uygun olarak hazırlanmış bir testle değerlendirilmiştir. Hastalar 6 ay boyunca izleme alınmış ve her ay AKŞ değerleri kontrol edilmiş, 3 ayda bir de serum kolesterolü, VKİ ve HbAlc değerleri ölçülmüştür. 6 aylık izlem süresinin sonunda hastaların metabolik kontrol değişkenlerinin herbirinde ilgili değişkennin normal değerine doğru değişen istatiksel olarak anlamlı bir değişim olmuştur. Hastaların eğitim sonrası bilgi düzeylerinde istatiksel olarak anlamlı bir artış saptanmıştır. Gündelik hayatta daha sık kullanılan bilgilerle ilgili değişimin daha fazla olduğu ve bilgilerin unutulmadığı görülmüştür. Ancak bilgi düzeyindeki değişim ve metabolik kontrol değişkenlerindeki değişim arasında bir ilişki saptanmamıştır. Araştırmanın sonuçlan; hasta eğitiminin, hastaların diyabet konsundaki bilgi düzeylerini olumlu yönde etkilediğini ancak bilginin tek başına hastalığın seyrini doğrudan değiştiremediğini düşündürtmüştür. Verilerin doğrulanabilmesi için daha uzun süreli araştırmalara ihtiyaç bulunmaktadır. IMPACTS OF DIABETIC PATIENT EDUCATION ON THE COURSE OF DIABETES Abstract Supporting patients in managing life with diabetes demands not only good medical knowledge but also good communication skills in members of diabetes team. This study was conducted with 150 adult type 2 diabetes patients to describe impact of patient education on both knowledge of diabetes mellitus and changes in some metabolic control parameteres. Medical history and demographic data was collected from 150 NIDDM patients.. Fasting blood glucose levels, HbAlc, serum lipids, arterial blood pressure and body mass index (BMI) were recorded before and after education. Education included participative methods such as brainstorming and role-playing. After education and on each visit, patients filled a questionnaire on knowledge about diabetes mellitus. A significant increase in knowledge was found. All metabolic control parameters including fasting blood glucose levels, HbAlc, serum lipids, arterial blood pressure and BMI improved significantly. Increased level of knowledge was not found to be correlated with the reduced level of metabolic control parameters. The results of the study showed a positive change in level of knowledge and on the level of the metabolic control parameters but the `knowledge` itself did not seem to have direct impact on the course of disease. '^J^öcıü.ryfiauma 64

Background While bio-medically, menopause could be treated as an illness, from a psychosocial and cultural perspective it could be seen as a "natural" process without requiring medication unless severe symptoms are present. Our objective is to explore the perceptions of Turkish women regarding menopause and Hormone Therapy (HT) to provide health care workers with an insight into the needs and expectations of postmenopausal women. Methods A qualitative inquiry through semi-structured, in-depth interviews was used to explore the study questions. We used a purposive sampling and included an equal number of participants who complained about the climacteric symptoms and those who visited the outpatient department for a problem other than climacteric symptoms but when asked declared that they had been experiencing climacteric symptoms. The interview questions focused on two areas; 1) knowledge, experiences, attitudes and beliefs about menopause and; 2) menopause-related experiences and ways to cope with menopause and perception of HT. Results Most of the participants defined menopause as a natural transition process that one should go through. Cleanliness, maturity, comfort of not having a period and positive changes in health behaviour were the concepts positively attributed to menopause, whereas hot flushes, getting old and difficulties in relationships were the negatives. Osteoporosis was an important concern for most of the participants. To deal with the symptoms, the non-pharmacological options were mostly favoured. Conclusion To our knowledge, this is the first qualitative study which focuses on Turkish women's menopausal experiences. Menopause was thought to be a natural process which was characterised by positive and negative features. Understanding these features and their implications in these women's lives may assist healthcare workers in helping their clients with menopause.