Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration

Abstract

Background There is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients’ knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown. Objective The objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals’ knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals’ behavior. Methods We included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors. Results A total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias. Conclusions Digital education seems to be more effective than traditional education in improving diabetes management–related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals’ behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries.

Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

“…We are also aware of recent reviews, which reached similar conclusions [55-62]. For example, digital education seems to be at least as effective (and sometimes more effective) as traditional education in improving dermatology, diabetes management, or smoking cessation–related skills and knowledge [58,61,62]. Most of these reviews, however, stressed the inconclusiveness of overall findings mainly because of the low certainty of the evidence.…”

Digital Education in Health Professions: The Need for Overarching Evidence Synthesis

“…In addition, we adopted alternative approaches to literature synthesis, keeping in mind the needs of various stakeholders in health professions education [34]. We have focused our evidence synthesis on digital education for a specific topic or condition (eg, smoking cessation [20], diabetes [21], domestic violence, and antibiotic management), discipline (eg, dermatology [10], pediatrics, geriatrics, leadership, and management [14]), roles of health professionals (eg, medical doctors [18], medical students [17], and preregistration [undergraduate] and postregistration [postgraduate] health professionals [11]), pedagogical foundations with relevant technology applications (eg, digital problem-based learning [35]), and type of outcome (eg, cognitive skills such as communication or diagnostic skills) [12].…”

“…We attempted to explore possible clinical or methodological reasons for this variation by performing prespecified subgroup analysis. In most reviews, high heterogeneity precluded statistical pooling [10-12,20,21], and prespecified subgroup analyses did not provide an explanation for the observed heterogeneity. In such cases, we performed a narrative synthesis of findings.…”

WHO guidance for digital health: What it means for researchers

“…4 In another systematic review of 12 studies (1990-2017), digital education was found to be more effective than traditional education to enhance knowledge and skills for diabetes management. 5 However, the low quality of these studies makes it difficult to formulate firm conclusions.…”