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Pediatr Diabetes. 2019 Jan 16. doi: 10.1111/pedi.12815. [Epub ahead of print]

Online education for gluten-free diet teaching: Development and usability testing of an e-learning module for children with concurrent celiac disease and type 1 diabetes.

Author information

1
Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
2
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.
3
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
4
Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada.
5
Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada.
6
Translational Medicine Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
7
The Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
8
The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND AND OBJECTIVE:

Celiac disease (CD), the most common genetically-based food intolerance, affects 3% to 16% of children with type 1 diabetes (T1D). Treatment involves lifelong adherence to a gluten-free diet (GFD). Individualized dietary education is resource-intensive. We, therefore, sought to develop and test the usability of an e-learning module aimed at educating patients and caregivers regarding implementation of the GFD in children with concurrent CD and T1D.

METHODS:

An interactive e-learning module was developed based on extensive review of CD, T1D, and educational literature. A mixed-methods usability testing approach was used to refine and evaluate the module, using qualitative semi-structured interviews, observations, and satisfaction and knowledge questionnaires in two iterative cycles. The module was refined based on themes identified from each usability cycle.

RESULTS:

Eighteen patients (8 in cycle 1, 10 in cycle 2) and 15 caregivers (7 in cycle 1, 8 in cycle 2) participated. Patient participants had CD and T1D for a mean (SD) of 6.1 ± 5.1 and 8.3 ± 5.5 years, respectively. Their mean age was 13.5 ± 4.5 years. Thematic analysis of usability interviews showed the module to be appealing and resulted in minor module revisions after each cycle to improve usability. Mean satisfaction scores post-module completion were high (4.67 ± 0.54), indicating participants were "very satisfied" with the education. Knowledge test scores increased significantly from pre- to post-module completion (P = 0.001).

CONCLUSION:

A multifaceted user-centered usability approach demonstrated that an innovative, interactive e-learning module is effective in knowledge retention and can provide comprehensive and accessible information in the implementation of the GFD teaching in children with CD and T1D.

KEYWORDS:

celiac disease; gluten-free diet; online education; patient education; type 1 diabetes

PMID:
30652421
DOI:
10.1111/pedi.12815

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