Diabetes Knowledge and Attitudes among Special Needs Assistants: A Pilot Study

The role of the Special Needs Assistant (SNA) is to provide support for children with significant care needs, including those with type 1 diabetes (T1DM). As up to 50% of Irish primary school children with T1DM report access to an SNA, we undertook the first ever study regarding the diabetes knowledge and attitudes of SNAs. Previous studies assessing teachers knowledge regarding T1DM demonstrated adequate knowledge in 16-33%1,2.

There is currently no database or mailing list for SNAs nationally, limiting research of this kind. Consequently, a link to an anonymous online Survey Monkey® questionnaire, to be shared with SNAs, was embedded in an electronic article regarding T1DM in school, distributed through the Irish Primary Principals Network (IPPN). It was not possible to establish the number of SNAs with whom the survey link was shared. The knowledge component, utilised a previously validated questionnaire ‘Test your Diabetes Knowledge’, consisting of 13 multiple-choice questions scoring +1, -1 or zero for correct, incorrect and don’t know responses respectively3. A total score of ≥ 7 indicated good knowledge. A five-statement Likert-based subscale of the current Diabetes Attitudes Scale (DAS-3) was used to assess SNA attitudes regarding the psychosocial impact on children with T1DM4. Data were analysed using StatsDirect™ version 2.7.8.

There were 83 respondents, 51 (61%) of whom were currently providing for the care needs of a pupil with T1DM. Twenty eight (35%) displayed good diabetes knowledge (score ≥ 7) rising to 43% and 47% respectively in SNAs with diabetes training and a current pupil with diabetes respectively. Sixty-seven (81%) respondents correctly identified appropriate preparation for sporting activities and 63 (76%) the appropriate treatment for hypoglycaemia during PE class. While 64 (77%) were able to identify common symptoms of hypoglycaemia, only 41 (49%) chose an appropriate treatment, when options were presented in multiple-choice format. Alarmingly, only 23 (28%) recognised the symptoms of an untreated hypoglycaemic event. When presented with an unconscious child with diabetes, 60 (72%) identified the need to use the recovery position and call an ambulance. Diabetes training and a current pupil with T1DM were significantly associated with a score ≥ 7 compared to having neither (13/31 (42%) vs. 3/22 (13.6%); p=0.03 (Fishers exact)). Individually, neither diabetes training nor currently having a student with T1DM were associated with a score ≥ 7 however the latter approached significance (p=0.057). Seventy three (88%) completed the Diabetes Attitude component which broadly indicated good understanding regarding the impact of diabetes on the pupil and their families.

When diabetes training sessions are provided to school personnel, and even to peers, diabetes control and the quality of life of children with diabetes significantly improves. Strengths of this study include the use of previously validated questionnaires for both the knowledge and attitude assessments. Limitations of this study include the small sample size and the possibility of response bias. Based on the knowledge deficits identified, diabetes training for school personnel involved in providing for care needs of pupils with T1DM needs to be addressed through the National Paediatric Diabetes working group.

S A Hurley1, P McCabe2, A Torrance3, M J O’Grady1,4

1Department of Paediatrics, Midland Regional Hospital, Mullingar, Co. Westmeath
2Irish Primary Principals Network, Glounthaune, Co. Cork
3National Council for Special Education, Trim, Co. Meath
4Women’s and Children’s Health, University College Dublin, Belfield, Dublin 4.

Corresponding Author
Prof. Michael O’Grady, Regional Hospital Mullingar, Co. Westmeath
Email: michaelogrady@physicians.ie

References
1. Aycan Z, Önder A, Çetinkaya S, Bilgili H, Yıldırım N, Baş VN, Peltek Kendirci HN, Ağladıoğlu SY. Assessment of the knowledge of diabetes mellitus among school teachers within the scope of the managing diabetes at school program. J Clin Res Pediatr Endocrinol. 2012 Dec;4(4):199-203.2.
2. Gormanous M, Hunt A, Pope J, Gerald B. Lack of knowledge of diabetes among Arkansas public elementary teachers: implications for dietitians. J Am Diet Assoc. 2002 Aug;102(8):1136-8.
3. Husband A, Grebenc K, McKeile E, Packaud D. The effectiveness of a CD-ROM in educating teachers who have a student with diabetes. Diabet Res Clin Pract. 2000; 50:46
4. Anderson RM, Fitzgerald JT, Funnell MM, Gruppen LD. The third version of the Diabetes Attitude Scale. Diabetes Care 1998; 21: 1403-1407.

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