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Y axis: percentage observed according to each group.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Puiguriguer Ferrando, S. Miralles Corrales, G. Frontera Juan, C. Campillo-Artero, B. Barceló Martín" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Puiguriguer Ferrando" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Miralles Corrales" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Frontera Juan" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Campillo-Artero" ] 4 => array:2 [ "nombre" => "B." 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Bertran-Luengo, M. Jansà-Morató, M. Vidal-Flor, M. Núñez-Juárez, P. Isla-Pera, J. Escarrabill-Sanglas" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Bertran-Luengo" "email" => array:1 [ 0 => "bertran@clinic.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Jansà-Morató" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Vidal-Flor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Núñez-Juárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Isla-Pera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Escarrabill-Sanglas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Programa de Atención a la Cronicidad, Hospital Clínic, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Universidad de Barcelona, Facultad de Medicina y Ciencias de la Salud, Campus Clínic, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Guía metodológica para la elaboración de un programa estructurado de educación terapéutica: del diseño a la evaluación" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1691 "Ancho" => 2167 "Tamanyo" => 242175 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Contents of goal definition.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Variability in clinical practice is common in healthcare and is often acceptable and justified. It is a phenomenon that has also been observed in therapeutic patient education (TPE), a patient-centred process that addresses patient needs, resources, values, and strategies. It allows patients to improve their knowledge and skills in relation to their illness and its treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Multiple studies have demonstrated the beneficial effects of TPE,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> which include better quality of life, greater treatment adherence, and a reduction in complications.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Chronic conditions were expected to become the main cause of global death and disability by 2020.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Managing these diseases requires patients to become allies to health professionals<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and to be trained in managing their illnesses.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diabetes is one of the diseases that has provided the most evidence on the impact of TPE programs. The National Institute for Clinical Excellence (NICE) defines a structured TPE program as a planned, written, and ongoing programme that is comprehensive in its aims, flexible in its content, and which addresses the individual’s clinical and psychological needs, adapted to the cultural context and level of the individual to which it is targeted.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From the perspective of improving quality, we understand a TPE program to be a structured process that addresses a complex health intervention using knowledge from multiple disciplines and which should be assessed periodically.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The ultimate goal of a written structured program is that it enables the professionals involved to understand the reference framework for implementing a personalised program for each patient, what the program intends to achieve, the role of each of the agents involved, and how to evaluate the program.</p><p id="par0030" class="elsevierStylePara elsevierViewall">However, when creating a structured program, the lack of widely shared criteria illustrating the minimum content and the lack of guidance on how to draft said content in a systematic manner leads to multiple methods for planning programs, even within a single centre, and those programs can tend to seem scattered and non-standardised, resulting in confusion and limited utility. This was evidenced by the Hospital Clínic in the situation analysis performed in 2007<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and 2013.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The above-mentioned inventory, which also included the opinions of professionals involved in TPE, highlighted the need for training and tools to plan and assess said programs.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bearing in mind this complexity, the trend towards carrying out on-demand educational activities, and the need for patients to participate in all things related to their health,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–16</span></a> the aim of this study is to structure and organise some of the approaches that various benchmark sources within the TPE field have been using, with the hope of aiding professionals faced with the challenge of drafting a structured program.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">Within the framework of the TPE and Information Policy of Hospital Clínic, a multidisciplinary group of eight professionals was assembled (physicians, nurses, a sociologist and specialist in audio-visual communication representing a patient association) from various hospital departments and the university, all leaders in TPE, chronicity, quality, and clinical safety.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A thorough review of the published literature was performed, consulting PubMed and publications referenced in bibliographies extracted from this website. Specialists on the topic were also contacted, with a focus on the most common chronic diseases (diabetes, asthma, COPD, and cardiovascular diseases) and TPE programs. Information was selected on the formal aspects that a structured TPE program should address, including planning and sections that a written program should include. It was supplemented with evaluation criteria and examples for structuring educational activities.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The proposed methodological framework is based on the quality standards from the American Diabetes Association (ADA) and NICE,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> PRECEDE,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> the TPE guidelines from the Haute Autorité de Santé<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and it integrates the ‘patient included’ concept.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The proposed text was submitted for comments and suggestions to a virtual community of practice<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> comprised of hospital and primary care professionals with experience in TPE as well as participants in a course on TPE and Information methodology which included organising an educational activity as the final practical project.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The final text and recommendations were agreed on by the entire editorial group. A non-structured consensus method was used at a face-to-face meeting after individual reflection and brainstorming based on the initial proposal resulting from the bibliographic review.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Proposed procedure, by unanimous consensus for each of the sections, for planning a Structured Educational Program (Appendix. <a class="elsevierStyleCrossRef" href="#sec0065">Supplementary material</a>):</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">1 Preliminary understandings: identification of the problem, health workers, and intervening hospital departments</span></p><p id="par0075" class="elsevierStylePara elsevierViewall">Starting with the analysis of significant conditions that are likely to be subject to educational intervention, the agents involved are identified and, with their participation, possible intervention strategies are identified and designed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">It is important to consider the expectations of each of the agents and their level of involvement from the start of program planning. According to the participatory design concept,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,20</span></a> it may be interesting to include patients starting from the conception of the program.</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">2 Situation analysis</span></p><p id="par0090" class="elsevierStylePara elsevierViewall">Provide preliminary understanding of the problem to be addressed, epidemiological, sociodemographic, and cultural aspects of the target population, and the approach to date in the centre and other institutions. Therefore, in addition to technical and scientific knowledge of the issue, try to keep in mind the everyday experience and perceptions of the individuals involved, and justify the need for the program and its adaptation to the centre’s TPE policy.</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">3 Identification of resources for program implementation</span></p><p id="par0100" class="elsevierStylePara elsevierViewall">TPE is multidisciplinary, interactive, participatory and based on theories and models of learning and behavioural models, not only on intuition and biomedical knowledge.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a> Therefore, professionals must be familiar with these theories and models.</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is thus necessary to bear in mind these TPE characteristics when identifying resources, both human as well as material, administrative, and organisational, that are available and necessary for implementing a structured program.</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">4 Definition of goals</span></p><p id="par0115" class="elsevierStylePara elsevierViewall">Types of goals to be defined:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0120" class="elsevierStylePara elsevierViewall">General: health condition to achieve.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0125" class="elsevierStylePara elsevierViewall">Intermediate: behaviours related to the health goal the patient hopes to achieve. Behaviours related to pharmacological and non-pharmacological treatment and self-monitoring techniques, other treatments, etc.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0130" class="elsevierStylePara elsevierViewall">Educational: knowledge, skills, and attitudes expected to be achieved, in relation to the envisioned health behaviours.</p></li></ul></p><p id="par0135" class="elsevierStylePara elsevierViewall">The definition of goals must specify the elements listed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">5 Drafting of the written program</span>, including, in addition to the situational analysis, the following sections:</p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Program structure</span></span><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">a</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Identification</span><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0155" class="elsevierStylePara elsevierViewall">Program name.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0160" class="elsevierStylePara elsevierViewall">People and departments in charge.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0165" class="elsevierStylePara elsevierViewall">Start date.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">b</span><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Target population</span><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par0175" class="elsevierStylePara elsevierViewall">Population encompassed by the program: illness or condition, stage of the disease, age, presence of comorbidities, patients and/or family members/caregivers.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">•</span><p id="par0180" class="elsevierStylePara elsevierViewall">Setting: outpatient services, day hospitals, or others.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">•</span><p id="par0185" class="elsevierStylePara elsevierViewall">Referral channels for inclusion in the program.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">c</span><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Resources</span><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">•</span><p id="par0195" class="elsevierStylePara elsevierViewall">Human resources: number and discipline of the professionals involved.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">•</span><p id="par0200" class="elsevierStylePara elsevierViewall">Training for professionals in the illness and in TPE.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par0205" class="elsevierStylePara elsevierViewall">Material resources: classrooms for groups, support materials, etc.</p></li></ul><span class="elsevierStyleVsp" style="height:0.5px"></span></p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">d</span><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Program aims</span>, defined as stated in section 4 and grouped according to the type of goal. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> presents the proposed formulation and an example, based on diabetes, for each type of goal:<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">•</span><p id="par0215" class="elsevierStylePara elsevierViewall">General (health-related). This can also be prevention or health promotion. In this case, the standard, percentage, and time do not need to be used. <span class="elsevierStyleItalic">Example: Preventing exercise-induced hypoglycaemia.</span> We can determine if patients have had hypoglycaemia, but we cannot compare this to the prior situation if we do not have specific data. If we know the patients’ mean number of hypoglycaemic episodes, we can define the following: <span class="elsevierStyleItalic">Within 12 months, 80% of patients who exercised experienced an 80% decrease in the number of hypoglycaemic episodes.</span></p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li></ul></p><p id="par0225" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0115"><p id="par0230" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0065"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">•</span><p id="par0235" class="elsevierStylePara elsevierViewall">Intermediate (behaviour-related). Some diseases have questionnaires that evaluate treatment adherence with different behaviours. This is something to keep in mind.</p></li></ul></p></li></ul></p><p id="par0240" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0070"><li class="elsevierStyleListItem" id="lsti0125"><p id="par0245" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0075"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">•</span><p id="par0250" class="elsevierStylePara elsevierViewall">Educational (knowledge, skills, and attitudes). Disease-specific knowledge questionnaires also exist. If a specific questionnaire is available, for example the DKQ2<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> on diabetes knowledge, we can establish knowledge goals such as: <span class="elsevierStyleItalic">In a 6-month period, 70% of participants will obtain an average score of 27/35 on the DKQ2 diabetes knowledge questionnaire. Maximum score 35/35.</span></p></li></ul></p></li></ul></p><p id="par0260" class="elsevierStylePara elsevierViewall">In addition to questionnaires, other tools that can be used to assess skills and attitudes include observation and level of participation. Indirectly, behavioural results can be useful for evaluating goals related to attitudes.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">The process as followed by the patient</span></span><ul class="elsevierStyleList" id="lis0080"><li class="elsevierStyleListItem" id="lsti0135"><p id="par0270" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0085"><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">•</span><p id="par0275" class="elsevierStylePara elsevierViewall">Initial evaluation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>): typically during an individual visit which allows us to identify the patient’s needs and construct a personalised program.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">•</span><p id="par0280" class="elsevierStylePara elsevierViewall">Activities and methodology: format and content of the sessions, facilitating interaction with the patient and their family/caregiver (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The program goals and content must be consistent.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">•</span><p id="par0285" class="elsevierStylePara elsevierViewall">With the aim of promoting care continuity, the patient’s medical history must include educational diagnosis, individual evaluation, decisions taken with the patient and interventions implemented.</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">•</span><p id="par0290" class="elsevierStylePara elsevierViewall">Final evaluation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>): type of evaluation, tools, and logging system. Identify the skills the patient must acquire, how their progress will be evaluated, and the benefit or suitability of the program.</p></li></ul></p></li></ul></p><p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Evaluation of the structure</span></span></p><p id="par0300" class="elsevierStylePara elsevierViewall">Evaluate the quantity, quality, and availability of facilities, and the material, human and financial resources commissioned for implementation of the program.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Evaluation of the process</span></span></p><p id="par0310" class="elsevierStylePara elsevierViewall">Evaluate professional practice on its own, quantitatively and qualitatively, the technical quality of the actions, activities, the organisation, and the professional-patient relationship.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Evaluation of the results</span></span></p><p id="par0320" class="elsevierStylePara elsevierViewall">For an evaluation to be adequate, it is essential that the written program include a method of measuring, processing, and logging the information obtained and which is required for calculating the expected indicators, and individuals responsible for obtaining it.</p><p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Patient results:</span> according to the specific goals defined for each patient (clinical parameters, self-management behaviours, knowledge, skills, attitude, familial support), with some results measures typically associated with a certain disease.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Chiefly these will be the same as those of the program but evaluated individually and in comparison to the baseline characteristics. Therefore, this evaluation is based on the patient’s educational and medical follow-up, incorporating information from the professionals involved, the patient, and their environment.</p><p id="par0330" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Program results</span>: definition of indicators according to the program goals and the frequency of evaluation.</p><p id="par0335" class="elsevierStylePara elsevierViewall">Monitoring indicators is a quality improvement method; indicators must be reliable, and it is essential to properly define them. To construct an indicator, it is necessary to define the variables that comprise it as well as standardised collection procedure.</p><p id="par0340" class="elsevierStylePara elsevierViewall">The purpose of evaluating and monitoring the selected indicators is to uncover and understand the utility and dynamics of the processes of the educational program, to evaluate changes, and to detect improvement opportunities. It is advisable to have measurement standards or, alternatively, baseline data that allow you to evaluate changes resulting from program implementation or improvement thereof. Some examples of indicators are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0345" class="elsevierStylePara elsevierViewall">When evaluating program results, it is important to consider the experience of the patients and caregivers throughout the process of the program; this can be done via individual interview or focus groups.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Program implementation</span><p id="par0350" class="elsevierStylePara elsevierViewall">The aim is to put into practice what was previously planned. However, it is advisable to first perform a test pilot so you can adapt and validate the proposed idea. This preliminary exploration includes analysing the context, defining and simulating an intervention, and performing an evaluation using both quantitative and qualitative methods. The results will be taken into account when scaling and generalising the program.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Obtaining indicators (evaluation and monitoring system)</span><p id="par0355" class="elsevierStylePara elsevierViewall">As with any other health intervention, the patient’s TE must be evaluated. This is a complex task due to the myriad elements that affect its organisation, implementation, and assessment; however, the effects of a TPE program can be evaluated if the written program includes an adequate definition of the goals and indicators, if the information required for measuring them is recorded, and if properly designed studies are used.</p><p id="par0360" class="elsevierStylePara elsevierViewall">TPE programs are part of a policy that, over the mid- to long-term, should benefit secondary and tertiary prevention. Therefore, in addition to the indicators resulting from direct information collection during the educational program, which are mentioned in the “Program results” section, some criteria that should be included in the evaluation is that related to the program’s impact in economic, social, and morbidity and mortality terms.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Identifying opportunities for improvement</span><p id="par0365" class="elsevierStylePara elsevierViewall">Measuring the experience of both participants and professionals and the perceived usefulness of the program will help identify opportunities for improvement, providing supplementary information to the quantitative evaluation of the program results.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Regular program updates</span><p id="par0370" class="elsevierStylePara elsevierViewall">Any opportunity for improvement detected during program follow-up should lead to modification of the written program. Nevertheless, is it convenient to establish a minimum review frequency; this will guarantee revision of the validity of the program contents and analysis of how it is implemented and its impact, in the case it were necessary to redefine certain activities, tasks, or levels of participation.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0375" class="elsevierStylePara elsevierViewall">The literature may be able to satisfy the need for program contents and the definition of educational activities, but not in terms of adapting TPE programs to situations encompassing multiple pathologies or long-term follow-up to enable patients to sustain their habits over time.</p><p id="par0380" class="elsevierStylePara elsevierViewall">Due to the limitations in the current literature, the methodological guide has been based on professional consensus with consulting from experts and professionals involved in educational activities. It is essentially a guide, and therefore will require specific adaptation to the condition to be addressed under the program as well as to the target population.</p><p id="par0385" class="elsevierStylePara elsevierViewall">The writing of the guide, submitted for assessment to professionals directly involved in TPE and various hospital environments, represents in and of itself an improvement in TPE quality at the centre, encouraging communication and the sharing of opinions among professionals.</p><p id="par0390" class="elsevierStylePara elsevierViewall">It has been used as a guide for planning programs designed as practical tasks for courses on the methodology of ET and information, thereby promoting the use of this procedure, achieving improved program quality.</p><p id="par0395" class="elsevierStylePara elsevierViewall">This methodological guide will make it possible to standardise structured written programs within the centre, facilitating their logging which, when available to the entire organisation, will prevent duplication improve the quality of educational interventions, and result in increased efficiency.</p><p id="par0400" class="elsevierStylePara elsevierViewall">We must understand the written TPE program as a framework for implementing a personalised program for each patient.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The patients themselves must participate in the design, monitoring, and evaluation of the program and be informed of the results.</p><p id="par0405" class="elsevierStylePara elsevierViewall">Program evaluation is based on criteria and indicators that take in consideration clinical-biological, pedagogical, psychological, social, organisational, and economic aspects. However, since TPE is an ongoing process that accompanies patients over the course of their illness or condition, its evaluation must also be continuous and long-term.</p><p id="par0410" class="elsevierStylePara elsevierViewall">Evaluating a program not only entails measuring the achieved goals, but also measuring effects in terms of changes. Therefore, evaluation must comprise part of the educational process and be included in the program design.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0415" class="elsevierStylePara elsevierViewall">This interdisciplinary methodological contribution proposes facilitating the planning and drafting of structured TPE programs while taking into account social factors and the participation of the patient, family members, and caregiver from the program’s conception. All TPE, from planning through to evaluation, must be fundamentally patient-centred and must improve the professional-patient relationship.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0420" class="elsevierStylePara elsevierViewall">This research did not receive any specific funding from agencies from the public sector, commercial sector, or not-for-profit organisations.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0425" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1580902" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1423194" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1580901" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1423195" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Program implementation" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Obtaining indicators (evaluation and monitoring system)" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Identifying opportunities for improvement" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Regular program updates" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack558382" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-03" "fechaAceptado" => "2019-12-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1423194" "palabras" => array:4 [ 0 => "Patient education" 1 => "Improvement in quality" 2 => "Quality of health care" 3 => "Chronic disease" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1423195" "palabras" => array:4 [ 0 => "Educación del paciente" 1 => "Mejoramiento de la calidad" 2 => "Calidad de la atención de salud" 3 => "Enfermedad crónica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Therapeutic patient education (TPE) is effective and essential in the context of the growing prevalence of chronic diseases in which tools are needed for planning structured programs. The objective of this project was to develop guidelines for designing and assessing a TPE program.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">1) We assembled a multidisciplinary group of 8 leaders in TPE, chronicity, quality and safety from the hospital and the university. 2) We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients, their relatives and caregivers. 3) The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology. The recommendations were unanimously agreed upon by the writing group.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We obtained a standardised work procedure targeted at professionals involved in planning TPE programs, based on international recommendations. The document is structured into sections: a) Definition of the health problem and analysis of the situation; b) Program structure (human resources and materials); objectives (health-related, behaviour-related and educational) and methodology; c) Path the patient and family/caregiver follows in the program; and d) Assessment and indicators.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Assessment of the procedure, within the framework of the methodology courses, was favourable.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The methodology provided by this document serves as an instrument for the standardised and systematic planning of educational programs and unifies the criteria in their drafting. However, the document needs to be adapted to the condition and population to which each program is addressed.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La educación terapéutica (ET) es eficaz e imprescindible en un contexto de prevalencia creciente de enfermedades crónicas, siendo necesarias herramientas para la planificación de programas estructurados. El objetivo fue elaborar una guía para el diseño y evaluación de un programa de <span class="elsevierStyleBold">ET</span>.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">1) Se constituyó un grupo multidisciplinario de <span class="elsevierStyleBold">ocho referentes en ET, cronicidad, calidad y seguridad, del hospital y la Universidad</span>. 2) Se realizó una revisión exhaustiva de la literatura científica sobre planificación de programas de ET dirigidos a pacientes crónicos, familiares o cuidadores. 3) El texto final se sometió a comentarios y sugerencias de participantes, del <span class="elsevierStyleBold">hospital y de atención primaria,</span> en un curso sobre metodología de Información y <span class="elsevierStyleBold">ET</span>. Las recomendaciones fueron consensuadas<span class="elsevierStyleBold">, por unanimidad,</span> por el grupo redactor.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se obtuvo un procedimiento normalizado de trabajo dirigido a profesionales implicados en planificación de programas de ET, basado en recomendaciones internacionales. El documento está estructurado en apartados: a) Definición del problema de salud y análisis de situación. b) Estructura del programa (recursos humanos y materiales); objetivos (salud, conducta y educativos) y metodología. c) Circuito que sigue el paciente y familia/cuidador en el programa. d) Evaluación e indicadores.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La evaluación del procedimiento, en el marco de los cursos de metodología, fue favorable.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La metodología aportada por este documento servirá de instrumento para planificar de forma homogénea y sistematizada los programas educativos, unificando criterios en su redacción.<span class="elsevierStyleBold">Sin embargo, requerirá su adaptación a la condición y la población a que se dirija cada programa.</span></p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Bertran-Luengo MJ, Jansà-Morató M, Vidal-Flor M, Núñez-Juárez M, Isla-Pera P, Escarrabill-Sanglas J. Guía metodológica para la elaboración de un programa estructurado de educación terapéutica: del diseño a la evaluación. Rev Clin Esp. 2021;221:448–455.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0440" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1691 "Ancho" => 2167 "Tamanyo" => 242175 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Contents of goal definition.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3468 "Ancho" => 2320 "Tamanyo" => 837029 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Program aims.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Initial educational assessment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient’s results evaluation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, level of health literacy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Social and cultural history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical/laboratory data, toxic habits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Technical skills<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Attitudes<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quality of life perception<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Self-management behaviours. Treatment adherence<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other aspects<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2708177.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Validated questionnaires can be used.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Via observation.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Culture, ability to express themselves, behaviour, level of anxiety or depression, use of resources, ability to perform activities of daily living.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Elements to consider in the patient’s initial and final program evaluation.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Activities</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Individual visits (number) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Group classes (number of sessions, duration, number of participants/groups, duration of each session) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Telematic appointments (number): telephone and/or other virtual communication systems \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Methodology</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lecture-one-way \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Active-participatory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Structured interview \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2708178.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Activities and methodology used in the therapeutic education program.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of patients who achieve their health, behavioural, and educational goals (level of health achieved, quality of life, treatment adherence, and adherence to recommendations, knowledge, skills and attitudes) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of patients or family members who complete the program \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of patients who did not complete the program and reasons \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of patients or family members satisfied with the program \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of involved professionals who express satisfaction with the program \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Impact on the hospital (for example, percentage of reduced visits to emergency departments and hospital admissions) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2708176.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Examples of indicators in a therapeutic education program.</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.zip" "ficheroTamanyo" => 290 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic education of diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. 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