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and a reduction in complications&#46;<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&#46;<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&#44;8</span></a> and to be trained in managing their illnesses&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;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&#46; The National Institute for Clinical Excellence &#40;NICE&#41; defines a structured TPE program as a planned&#44; written&#44; and ongoing programme that is comprehensive in its aims&#44; flexible in its content&#44; and which addresses the individual&#8217;s clinical and psychological needs&#44; adapted to the cultural context and level of the individual to which it is targeted&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From the perspective of improving quality&#44; 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&#46;</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&#44; what the program intends to achieve&#44; the role of each of the agents involved&#44; and how to evaluate the program&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; when creating a structured program&#44; 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&#44; even within a single centre&#44; and those programs can tend to seem scattered and non-standardised&#44; resulting in confusion and limited utility&#46; This was evidenced by the Hospital Cl&#237;nic in the situation analysis performed in 2007<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The above-mentioned inventory&#44; which also included the opinions of professionals involved in TPE&#44; highlighted the need for training and tools to plan and assess said programs&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bearing in mind this complexity&#44; the trend towards carrying out on-demand educational activities&#44; and the need for patients to participate in all things related to their health&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;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&#44; with the hope of aiding professionals faced with the challenge of drafting a structured program&#46;</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 Cl&#237;nic&#44; a multidisciplinary group of eight professionals was assembled &#40;physicians&#44; nurses&#44; a sociologist and specialist in audio-visual communication representing a patient association&#41; from various hospital departments and the university&#44; all leaders in TPE&#44; chronicity&#44; quality&#44; and clinical safety&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A thorough review of the published literature was performed&#44; consulting PubMed and publications referenced in bibliographies extracted from this website&#46; Specialists on the topic were also contacted&#44; with a focus on the most common chronic diseases &#40;diabetes&#44; asthma&#44; COPD&#44; and cardiovascular diseases&#41; and TPE programs&#46; Information was selected on the formal aspects that a structured TPE program should address&#44; including planning and sections that a written program should include&#46; It was supplemented with evaluation criteria and examples for structuring educational activities&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The proposed methodological framework is based on the quality standards from the American Diabetes Association &#40;ADA&#41; and NICE&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> PRECEDE&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> the TPE guidelines from the Haute Autorit&#233; de Sant&#233;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and it integrates the &#8216;patient included&#8217; concept&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;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&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The final text and recommendations were agreed on by the entire editorial group&#46; 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&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Proposed procedure&#44; by unanimous consensus for each of the sections&#44; for planning a Structured Educational Program &#40;Appendix&#46; <a class="elsevierStyleCrossRef" href="#sec0065">Supplementary material</a>&#41;&#58;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">1 Preliminary understandings&#58; identification of the problem&#44; health workers&#44; 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&#44; the agents involved are identified and&#44; with their participation&#44; possible intervention strategies are identified and designed&#46;</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&#46; According to the participatory design concept&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;20</span></a> it may be interesting to include patients starting from the conception of the program&#46;</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&#44; epidemiological&#44; sociodemographic&#44; and cultural aspects of the target population&#44; and the approach to date in the centre and other institutions&#46; Therefore&#44; in addition to technical and scientific knowledge of the issue&#44; try to keep in mind the everyday experience and perceptions of the individuals involved&#44; and justify the need for the program and its adaptation to the centre&#8217;s TPE policy&#46;</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&#44; interactive&#44; participatory and based on theories and models of learning and behavioural models&#44; not only on intuition and biomedical knowledge&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Therefore&#44; professionals must be familiar with these theories and models&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is thus necessary to bear in mind these TPE characteristics when identifying resources&#44; both human as well as material&#44; administrative&#44; and organisational&#44; that are available and necessary for implementing a structured program&#46;</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&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">General&#58; health condition to achieve&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Intermediate&#58; behaviours related to the health goal the patient hopes to achieve&#46; Behaviours related to pharmacological and non-pharmacological treatment and self-monitoring techniques&#44; other treatments&#44; etc&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Educational&#58; knowledge&#44; skills&#44; and attitudes expected to be achieved&#44; in relation to the envisioned health behaviours&#46;</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&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">5 Drafting of the written program</span>&#44; including&#44; in addition to the situational analysis&#44; the following sections&#58;</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">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Program name&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">People and departments in charge&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Start date&#46;</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">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Population encompassed by the program&#58; illness or condition&#44; stage of the disease&#44; age&#44; presence of comorbidities&#44; patients and&#47;or family members&#47;caregivers&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Setting&#58; outpatient services&#44; day hospitals&#44; or others&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Referral channels for inclusion in the program&#46;</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">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Human resources&#58; number and discipline of the professionals involved&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Training for professionals in the illness and in TPE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Material resources&#58; classrooms for groups&#44; support materials&#44; etc&#46;</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>&#44; defined as stated in section 4 and grouped according to the type of goal&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> presents the proposed formulation and an example&#44; based on diabetes&#44; for each type of goal&#58;<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">General &#40;health-related&#41;&#46; This can also be prevention or health promotion&#46; In this case&#44; the standard&#44; percentage&#44; and time do not need to be used&#46; <span class="elsevierStyleItalic">Example&#58; Preventing exercise-induced hypoglycaemia&#46;</span> We can determine if patients have had hypoglycaemia&#44; but we cannot compare this to the prior situation if we do not have specific data&#46; If we know the patients&#8217; mean number of hypoglycaemic episodes&#44; we can define the following&#58; <span class="elsevierStyleItalic">Within 12 months&#44; 80&#37; of patients who exercised experienced an 80&#37; decrease in the number of hypoglycaemic episodes&#46;</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">&#8226;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Intermediate &#40;behaviour-related&#41;&#46; Some diseases have questionnaires that evaluate treatment adherence with different behaviours&#46; This is something to keep in mind&#46;</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">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Educational &#40;knowledge&#44; skills&#44; and attitudes&#41;&#46; Disease-specific knowledge questionnaires also exist&#46; If a specific questionnaire is available&#44; for example the DKQ2<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> on diabetes knowledge&#44; we can establish knowledge goals such as&#58; <span class="elsevierStyleItalic">In a 6-month period&#44; 70&#37; of participants will obtain an average score of 27&#47;35 on the DKQ2 diabetes knowledge questionnaire&#46; Maximum score 35&#47;35&#46;</span></p></li></ul></p></li></ul></p><p id="par0260" class="elsevierStylePara elsevierViewall">In addition to questionnaires&#44; other tools that can be used to assess skills and attitudes include observation and level of participation&#46; Indirectly&#44; behavioural results can be useful for evaluating goals related to attitudes&#46;<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">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Initial evaluation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; typically during an individual visit which allows us to identify the patient&#8217;s needs and construct a personalised program&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Activities and methodology&#58; format and content of the sessions&#44; facilitating interaction with the patient and their family&#47;caregiver &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The program goals and content must be consistent&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">With the aim of promoting care continuity&#44; the patient&#8217;s medical history must include educational diagnosis&#44; individual evaluation&#44; decisions taken with the patient and interventions implemented&#46;</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Final evaluation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; type of evaluation&#44; tools&#44; and logging system&#46; Identify the skills the patient must acquire&#44; how their progress will be evaluated&#44; and the benefit or suitability of the program&#46;</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&#44; quality&#44; and availability of facilities&#44; and the material&#44; human and financial resources commissioned for implementation of the program&#46;<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&#44; quantitatively and qualitatively&#44; the technical quality of the actions&#44; activities&#44; the organisation&#44; and the professional-patient relationship&#46;<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&#44; it is essential that the written program include a method of measuring&#44; processing&#44; and logging the information obtained and which is required for calculating the expected indicators&#44; and individuals responsible for obtaining it&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Patient results&#58;</span> according to the specific goals defined for each patient &#40;clinical parameters&#44; self-management behaviours&#44; knowledge&#44; skills&#44; attitude&#44; familial support&#41;&#44; with some results measures typically associated with a certain disease&#46;<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&#46; Therefore&#44; this evaluation is based on the patient&#8217;s educational and medical follow-up&#44; incorporating information from the professionals involved&#44; the patient&#44; and their environment&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Program results</span>&#58; definition of indicators according to the program goals and the frequency of evaluation&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">Monitoring indicators is a quality improvement method&#59; indicators must be reliable&#44; and it is essential to properly define them&#46; To construct an indicator&#44; it is necessary to define the variables that comprise it as well as standardised collection procedure&#46;</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&#44; to evaluate changes&#44; and to detect improvement opportunities&#46; It is advisable to have measurement standards or&#44; alternatively&#44; baseline data that allow you to evaluate changes resulting from program implementation or improvement thereof&#46; Some examples of indicators are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0345" class="elsevierStylePara elsevierViewall">When evaluating program results&#44; it is important to consider the experience of the patients and caregivers throughout the process of the program&#59; this can be done via individual interview or focus groups&#46;</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&#46; However&#44; it is advisable to first perform a test pilot so you can adapt and validate the proposed idea&#46; This preliminary exploration includes analysing the context&#44; defining and simulating an intervention&#44; and performing an evaluation using both quantitative and qualitative methods&#46; The results will be taken into account when scaling and generalising the program&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Obtaining indicators &#40;evaluation and monitoring system&#41;</span><p id="par0355" class="elsevierStylePara elsevierViewall">As with any other health intervention&#44; the patient&#8217;s TE must be evaluated&#46; This is a complex task due to the myriad elements that affect its organisation&#44; implementation&#44; and assessment&#59; however&#44; the effects of a TPE program can be evaluated if the written program includes an adequate definition of the goals and indicators&#44; if the information required for measuring them is recorded&#44; and if properly designed studies are used&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">TPE programs are part of a policy that&#44; over the mid- to long-term&#44; should benefit secondary and tertiary prevention&#46; Therefore&#44; in addition to the indicators resulting from direct information collection during the educational program&#44; which are mentioned in the &#8220;Program results&#8221; section&#44; some criteria that should be included in the evaluation is that related to the program&#8217;s impact in economic&#44; social&#44; and morbidity and mortality terms&#46;</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&#44; providing supplementary information to the quantitative evaluation of the program results&#46;</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&#46; Nevertheless&#44; is it convenient to establish a minimum review frequency&#59; this will guarantee revision of the validity of the program contents and analysis of how it is implemented and its impact&#44; in the case it were necessary to redefine certain activities&#44; tasks&#44; or levels of participation&#46;</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&#44; 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&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">Due to the limitations in the current literature&#44; the methodological guide has been based on professional consensus with consulting from experts and professionals involved in educational activities&#46; It is essentially a guide&#44; and therefore will require specific adaptation to the condition to be addressed under the program as well as to the target population&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">The writing of the guide&#44; submitted for assessment to professionals directly involved in TPE and various hospital environments&#44; represents in and of itself an improvement in TPE quality at the centre&#44; encouraging communication and the sharing of opinions among professionals&#46;</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&#44; thereby promoting the use of this procedure&#44; achieving improved program quality&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">This methodological guide will make it possible to standardise structured written programs within the centre&#44; facilitating their logging which&#44; when available to the entire organisation&#44; will prevent duplication improve the quality of educational interventions&#44; and result in increased efficiency&#46;</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&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The patients themselves must participate in the design&#44; monitoring&#44; and evaluation of the program and be informed of the results&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Program evaluation is based on criteria and indicators that take in consideration clinical-biological&#44; pedagogical&#44; psychological&#44; social&#44; organisational&#44; and economic aspects&#46; However&#44; since TPE is an ongoing process that accompanies patients over the course of their illness or condition&#44; its evaluation must also be continuous and long-term&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Evaluating a program not only entails measuring the achieved goals&#44; but also measuring effects in terms of changes&#46; Therefore&#44; evaluation must comprise part of the educational process and be included in the program design&#46;</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&#44; family members&#44; and caregiver from the program&#8217;s conception&#46; All TPE&#44; from planning through to evaluation&#44; must be fundamentally patient-centred and must improve the professional-patient relationship&#46;</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&#44; commercial sector&#44; or not-for-profit organisations&#46;</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&#46;</p></span></span>"
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              "titulo" => "Program implementation"
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              "titulo" => "Obtaining indicators &#40;evaluation and monitoring system&#41;"
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              "titulo" => "Identifying opportunities for improvement"
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          "titulo" => "Acknowledgements"
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          "titulo" => "References"
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    "fechaRecibido" => "2019-08-03"
    "fechaAceptado" => "2019-12-06"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Patient education"
            1 => "Improvement in quality"
            2 => "Quality of health care"
            3 => "Chronic disease"
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            0 => "Educaci&#243;n del paciente"
            1 => "Mejoramiento de la calidad"
            2 => "Calidad de la atenci&#243;n de salud"
            3 => "Enfermedad cr&#243;nica"
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    "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 &#40;TPE&#41; is effective and essential in the context of the growing prevalence of chronic diseases in which tools are needed for planning structured programs&#46; The objective of this project was to develop guidelines for designing and assessing a TPE program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">1&#41; We assembled a multidisciplinary group of 8 leaders in TPE&#44; chronicity&#44; quality and safety from the hospital and the university&#46; 2&#41; We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients&#44; their relatives and caregivers&#46; 3&#41; The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology&#46; The recommendations were unanimously agreed upon by the writing group&#46;</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&#44; based on international recommendations&#46; The document is structured into sections&#58; a&#41; Definition of the health problem and analysis of the situation&#59; b&#41; Program structure &#40;human resources and materials&#41;&#59; objectives &#40;health-related&#44; behaviour-related and educational&#41; and methodology&#59; c&#41; Path the patient and family&#47;caregiver follows in the program&#59; and d&#41; Assessment and indicators&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Assessment of the procedure&#44; within the framework of the methodology courses&#44; was favourable&#46;</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&#46; However&#44; the document needs to be adapted to the condition and population to which each program is addressed&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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            "titulo" => "Results"
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        "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 educaci&#243;n terap&#233;utica &#40;ET&#41; es eficaz e imprescindible en un contexto de prevalencia creciente de enfermedades cr&#243;nicas&#44; siendo necesarias herramientas para la planificaci&#243;n de programas estructurados&#46; El objetivo fue elaborar una gu&#237;a para el dise&#241;o y evaluaci&#243;n de un programa de <span class="elsevierStyleBold">ET</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">1&#41; Se constituy&#243; un grupo multidisciplinario de <span class="elsevierStyleBold">ocho referentes en ET&#44; cronicidad&#44; calidad y seguridad&#44; del hospital y la Universidad</span>&#46; 2&#41; Se realiz&#243; una revisi&#243;n exhaustiva de la literatura cient&#237;fica sobre planificaci&#243;n de programas de ET dirigidos a pacientes cr&#243;nicos&#44; familiares o cuidadores&#46; 3&#41; El texto final se someti&#243; a comentarios y sugerencias de participantes&#44; del <span class="elsevierStyleBold">hospital y de atenci&#243;n primaria&#44;</span> en un curso sobre metodolog&#237;a de Informaci&#243;n y <span class="elsevierStyleBold">ET</span>&#46; Las recomendaciones fueron consensuadas<span class="elsevierStyleBold">&#44; por unanimidad&#44;</span> por el grupo redactor&#46;</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 planificaci&#243;n de programas de ET&#44; basado en recomendaciones internacionales&#46; El documento est&#225; estructurado en apartados&#58; a&#41; Definici&#243;n del problema de salud y an&#225;lisis de situaci&#243;n&#46; b&#41; Estructura del programa &#40;recursos humanos y materiales&#41;&#59; objetivos &#40;salud&#44; conducta y educativos&#41; y metodolog&#237;a&#46; c&#41; Circuito que sigue el paciente y familia&#47;cuidador en el programa&#46; d&#41; Evaluaci&#243;n e indicadores&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La evaluaci&#243;n del procedimiento&#44; en el marco de los cursos de metodolog&#237;a&#44; fue favorable&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La metodolog&#237;a aportada por este documento servir&#225; de instrumento para planificar de forma homog&#233;nea y sistematizada los programas educativos&#44; unificando criterios en su redacci&#243;n&#46;<span class="elsevierStyleBold">Sin embargo&#44; requerir&#225; su adaptaci&#243;n a la condici&#243;n y la poblaci&#243;n a que se dirija cada programa&#46;</span></p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Bertran-Luengo MJ&#44; Jans&#224;-Morat&#243; M&#44; Vidal-Flor M&#44; N&#250;&#241;ez-Ju&#225;rez M&#44; Isla-Pera P&#44; Escarrabill-Sanglas J&#46; Gu&#237;a metodol&#243;gica para la elaboraci&#243;n de un programa estructurado de educaci&#243;n terap&#233;utica&#58; del dise&#241;o a la evaluaci&#243;n&#46; Rev Clin Esp&#46; 2021&#59;221&#58;448&#8211;455&#46;</p>"
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            "identificador" => "sec0065"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Contents of goal definition&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Initial educational assessment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age&#44; level of health literacy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Social and cultural history&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">X&nbsp;\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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Clinical&#47;laboratory data&#44; toxic habits&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                        "tituloSerie" => "Diabetes Metab Res Rev&#46;"
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        "texto" => "<p id="par0430" class="elsevierStylePara elsevierViewall">We would like to thank the members of the Therapeutic Education and Information Workgroup &#40;GTIET&#41; from Hospital Cl&#237;nic Imma Grau and Roser Cadena for their collaboration in revising the first draft&#44; their constructive feedback&#44; and advising during the design of these guidelines&#46;</p>"
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Original article
Methodological guidelines for preparing a structured therapeutic education program: From design to evaluation
Guía metodológica para la elaboración de un programa estructurado de educación terapéutica: del diseño a la evaluación
M.J. Bertran-Luengoa,
Corresponding author
bertran@clinic.cat

Corresponding author.
, M. Jansà-Moratób,c, M. Vidal-Florb, M. Núñez-Juárezd, P. Isla-Perae, J. Escarrabill-Sanglasc
a Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Barcelona, Spain
b Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain
c Programa de Atención a la Cronicidad, Hospital Clínic, Barcelona, Spain
d Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
e Universidad de Barcelona, Facultad de Medicina y Ciencias de la Salud, Campus Clínic, Barcelona, Spain

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