Preferred Name

Brandon D. Lipscomb

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Erica Lewis

Juhong Christie Liu



Background: Quality diabetes education is a key to successful diabetes treatment. Factors that hinder quality diabetes education include: allotted time for appointments, provider-patient communication, inter-personal relationship between provider and patient, and patient’s educational level. Locally speaking, the Central Virginia area has a higher rate of diabetes then compared to the average rate of diabetes in the State of Virginia. To complicate this more, the local area has a higher percentage of poverty when compared to the average poverty level of the state. Combining these two characteristics places these individuals at a higher risk for disease complications and expresses a need to remove barriers to quality diabetes education while providing a solution to the delivery of quality education during primary care appointments. The setting for this quality improvement project was a family medicine residency clinic in Central Virginia that provides care to a high number of these lower-socioeconomic patients, as compared to other localities, many of which have Type II diabetes. The aim of this quality improvement project was to design and introduce standardized education to primary care appointments. Outcome measurements included knowledge gain and patient satisfaction with the educational intervention.

Methods: The IHI Psychology of Change provided the framework for this quality improvement project. The IHI Psychology of Change framework utilizes five domains that intercorrelate to help produce and sustain quality improvement. Through these domains evidence-based interventions are implemented to improve patient care. The five domains include: Unleash Intrinsic Motivation; Co-Design People Change; Co-produce in Authentic Relationship; Distribute Power and Adapt in Action. In the context of this project, motivational change occurred at two levels, organizationally and individually.

Design thinking was the method used to design the educational intervention. The intervention was a video education module that was designed to meet stakeholder needs, including the end-users as patients, providers, and the institution.

A convenience sample of clinic patients who are 18 years or older and diagnosed with Type II diabetes were recruited to participate along with providers and institutional representatives. Qualitative interviews were used to gather data at each iteration. The Brief Diabetic Knowledge Test was used pre/post intervention to gather basic trends to further guide the design of the educational video which was the intervention in this study.

Findings/Results: Through 2 prototype iterations, a video education module was produced that satisfied the needs of a local group. The overall themes from both patients and providers was, “Patients with Type II diabetes need an achievable vision of a whole, healthy life”. This theme provided the foundation for the video education modules that included basics of Type II diabetes, nutrition, and safety. Patients that viewed the final prototype displayed an overall increase in Brief Diabetic Knowledge Test scores and perceived the video education as a valuable tool with a favorable score of 4 or higher in all categories of the End-User Satisfaction Survey. Utilizing Design Thinking method, the focus of the education was on the end-user. The methodology helped to produce a product that was patient-focused and also efficient in the clinical setting.

Conclusions : Individuals doing clinical education research in similar settings should look for an achievable vision to live a whole and healthy life. The Brief Diabetic Knowledge Test is likely to be useful for evaluating diabetes education. Design thinking can be used to create an intervention based on stakeholder needs in the clinical setting. When supported by other evidence-based research methods, design thinking can be a robust tool for quality improvement.

Key words: diabetic education, quality improvement, design thinking, access to care

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Nursing Commons



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