Effectiveness of a group diabetes education programme in under-served communities in South Africa: a pragmatic cluster randomized controlled trial.

AIM: To evaluate the effectiveness of group education, led by health promoters using a guiding style, for people with type 2 diabetes in public sector community health centres in Cape Town. METHODS: This was a pragmatic clustered randomized controlled trial with 17 randomly selected intervention and 17 control sites. A total of 860 patients with type 2 diabetes, regardless of therapy used, were recruited from the control sites and 710 were recruited from the intervention sites. The control sites offered usual care, while the intervention sites offered a total of four monthly sessions of group diabetes education led by a health promoter. Participants were measured at baseline and 12 months later. Primary outcomes were diabetes self-care activities, 5% weight loss and a 1% reduction in HbA(1c) levels. Secondary outcomes were self-efficacy, locus of control, mean blood pressure, mean weight loss, mean waist circumference, mean HbA1c and mean total cholesterol levels and quality of life. RESULTS: A total of 422 (59.4%) participants in the intervention group did not attend any education sessions. No significant improvement was found in any of the primary or secondary outcomes, apart from a significant reduction in mean systolic (-4.65 mmHg, 95% CI 9.18 to -0.12; P = 0.04) and diastolic blood pressure (-3.30 mmHg, 95% CI -5.35 to -1.26; P = 0.002). Process evaluation suggested that there were problems with finding suitable space for group education in these under-resourced settings, with patient attendance and with full adoption of a guiding style by the health promoters. CONCLUSION: The reported effectiveness of group diabetes education offered by more highly trained professionals, in well-resourced settings, was not replicated in the present study, although the reduction in participants' mean blood pressure is likely to be of clinical significance.

Assessment of the quality of interaction in distance learning programmes utilising the Internet (WebCT) or interactive television (ITV).

INTRODUCTION: This study focuses on the quality of interaction in interactive TV (ITV), WebCT bulletin boards (BBs) and chat rooms (CRs) and addresses the question of how effectively new collaborative electronic technologies have been married with new pedagogical ideas to create effective learning for distance education students. METHODS: Fifteen (out of 68) BB, 14 (out of 32) CR and 13 (out of 25) ITV conversations were randomly selected for coding using a modified exchange structure analysis. The roles that students and lecturers took in the conversations were determined from this. RESULTS: The percentage of turns made by lecturers as opposed to students was 51% in CRs, 14% in BBs and 68% in ITV. The percentage of turns spent on actual coursework was 73% in CRs, 89% in BBs and 82% in ITV. Comparisons between tutors' and students' roles within as well as between ITV, BBs and CRs were all statistically significant with P < 0.05. In CRs the main roles of both students and lecturers were those of elaborators, inquirers and explainers. In BBs the main roles of students and lecturers were those of explainers and evaluators. In ITV sessions students' main roles were those of elaborators and explainers, whereas lecturers' main roles were those of lecturers, elaborators, inquirers and evaluators. CONCLUSION: In terms of creating a constructivist and active learning community that can operate within a distance learning paradigm, WebCT appears superior to ITV.