Week No. Topics Sample Articles Examples of Weekly Assignments Example of Db Questions
1 Introduction to course (objectives, assignment)
Overview of diabetes as a PH issue
Tuchman 2009 [8]
Gregg et al. 2009 [9]
Since the students are of different disciplines, they shared their experiences and perspectives related to diabetes and the different roles they held (patient navigator, dialysis nurse). Exchanging their experiences allowed students to see different provider roles in teaching DSME Describe an experience you had when you have cared for a patient/family with diabetes.
Explain your role in teaching this person to manage their diabetes.
2 Etiology of diabetes (type 1, type 2 and gestational diabetes) ADA 2013 [10]
Agarwal et al. 2010 [11]
This exercise enabled the public health and nursing students to deepen their understanding of different types of diabetes.  They shared ideas and perspectives of different disciplines, what comprises a team and reasons they are important for people with diabetes. Define the type of diabetes in the person identified in week 1. 
Describe two needs of this person that affects how they manage their diabetes.
Name three disciplines other than your own that are essential members of the team, and explain their role in providing DSME.
3 Acute and long-term complications Marcovecchio et al. 2011 [12]
Scott et al.  2011 [13]
This exercise enabled the students to deepen their understanding of acute and long-term complications.  Students researched acute or long-term complications, and statistics.  They shared experiences of people they knew and cared for with acute and long-term complications. Identify and define two acute or long-term complications.
Discuss and describe how you would teach them.
For each of the two complications identified, what are two things you would teach them to manage these complications.
4 Metabolic Syndrome Grundy et al. 2012 [14]
Prasad et al. 2012 [15]
This exercise enabled the students to deepen their understanding of metabolic syndrome.  They learned from each other the risk factors for the different types of disorders (e.g., microalbuminuria) and risk factors (e.g., obesity) of metabolic syndrome. Define metabolic syndrome.
Identify and define three risk factors for metabolic syndrome and the impact they have on diabetes.
5 Cost implications of diabetes
Reimbursement for DSME
Out-of-pocket costs associated with diabetes
Dall et al. 2010 [16]
Desai et al. 2012 [17]
Students examined financial aspects (e.g., co-payments) affecting those with diabetes. They shared information and discussed issues that impact people with type 1 and type 2 diabetes and the out-of-pocket costs that affect them. Based on the responses, they were surprised at the large amount of out-of-pockets costs of people with diabetes and monies spent on diabetes care. Identify and discuss two financial costs a person with diabetes encounters.
Discuss how these two financial costs impact how a person with diabetes manages their diabetes.
6 Principles of Behavioral Modification Teaching and Learning (e.g. Stages of Change, CCM)   Students chose a behavioral modification teaching and learning theory/model they would use in developing a DSME plan for people with diabetes.  They shared and learned about different theories/models. Describe a behavioral modification theory/model you would use in practice in caring for people with diabetes.
Define the concepts/constructs of the theory/model.
7 Principles of Behavioral Modification Teaching and Learning (continued)   The students shared the chosen theory/model for a DSME and learned about its application from the perspective of their discipline (e.g., nursing or public health). Using the above theory/model, provide a detailed plan describing how you would use it as a framework in implementing DSME.  In the plan, include the topics of diabetes complications, medication compliance, glucose monitoring, weight loss and increasing physical activity.
8 Diabetes self-management in children/adolescent, adults, and pregnant women  Adi 2010 [18]
ADA 2010 [19]
This exercise reinforces the students’ understanding of different types of diabetes and its impact on different aspects of diabetes management.  Based on the responses, they identified aspects of diabetes management they overlooked before taking this course(e.g., carrying a glucometer and its supplies to dinner to check their glucose level).  Define a type of diabetes (type 1, type 2 or gestational diabetes); discuss two physical (e.g., checking blood glucose levels before administering insulin); two emotional (e.g., coping with lifestyle changes); and two psychosocial aspects (e.g., multiple daily insulin injections) experienced by the person with the type of diabetes defined.
9 Different types of medication therapy (insulin, oral agents, insulin pumps) Renda et al. 2011 [20] The students applied their role to educating a person on maintaining their medication regimen.  They shared different educational perspectives and views on medication adherence based on their disciplineand professional experiences. Identify and discuss two ways you could teach a person on insulin injections, oral medications and on an insulin pump to follow their medication regimen.
Identify two ways for each.
10 Nutrition and Healthy Eating
Carbohydrate counting
Dias et al. 2010 [21]
Franz et al. 2010 [22]
Students researched carbohydrate counting,  and nutritional aspects of different type of foods in order to develop an educational plan.  They provided insights on how they are prepared and compared foods that were healthy and unhealthy.  The students shared different educational plans through a cultural lens.  Based on the responses, many students were surprised about the carbohydrate amount in certain foods of their culture. Provide examples and details of foods of your culture, for each of the three meals (i.e., breakfast, lunch and dinner).
Include the food, calories and carbohydrate count for that food and total the amounts for each meal.
Discuss how you would educate this person on a balanced diet. What staple foods would you tell them to avoid and why?
Discuss how you will motivate them to overcome their barriers (e.g., eating bread).
11 Impact of HL, NL and GL in diabetes self-management Osborn et al. 2010 [23]
Osborn et al. 2009 [24]
Students examined interpretations of HL.  They explained the relationship between literacy and diabetes, provided examples of how they could assess a patient’s HL and methods they could use to promote HL.  Their responses indicated that they had not realized the number of resources available to assess and educate people on HL; and in the past had not applied the concept of HLtodiabetes education.  How do you define HL?
What is the relationship between HL and diabetes?
Discuss two ways HL is essential for someone with diabetes.
Discuss two ways low HL can impact a person manage their diabetes.
Discuss three methods you would use to assist the person with diabetes become more HL.
12 Impact of HL, NL and GL in diabetes self-management (continuation)   Students examined interpretations of NL and GL.  They explained the relationship between NL and diabetes, and GL and diabetes; provided examples of how they could assess a patient’s NL and GL, and methods they could use to promote NL.   Their responses indicated that they had not realized the number of resources available to assess and educate people on NL.  They also indicated not realizing the number of people with GL and the impact it has on people with diabetes. How do you define NL and GL?
What is the relationship between NL and diabetes and GL and diabetes?
Discuss two ways NL is essential for someone with diabetes,
Discuss two ways low NL can impact how a person manages their diabetes and two ways a lack of GL can impact how a person manages their diabetes.
Discuss three methods you would use to assist the person with diabetes become more numerically literate.
13 Epidemiology of diabetes and disparities among different ethnic groups
CC in diabetes education (cultural diet and complementary therapies)
CLAS
Aponte 2009 [25]
Kalter-Leibovici et al. 2012 [26]
Students completed an online CC exam the faculty member posted from A Physician’s Practical Guide to Culturally Competent Care.  Questions were selected from this guide, which is a self-directed training course for HCP with a specific interest in CC.  Topics in the exam included CC, CLAS, health disparities.  The students had 1 week to complete the exam and were able to take it multiple times. The exam had a total of 30 multiple choice questions.  Students could only answer one question at a time, and the questions were randomized each time the student retook the exam.  Cultural competency exam.  The link is https://cccm.thinkculturalhealth.hhs.gov/GUIs/GUI_AboutthisSite.asp#top They needed to receive an 80% or greater in order to receive credit for the assignment.
14 Psychosocial assessment
Depression and diabetes
Hillege et al. 2011 [27]
Skinner et al. 2010 [28]
Questions focused on psychosocial issues affecting those with diabetes.  Students researched depression and emotional issues.  They shared personal and professional experiences, shared methods to approach a person with depression, and provided insights on how to best manage depression and psychosocial issues in people with diabetes.  Discuss two reasons a person with diabetes may become depressed and describe two ways you would try to reduce their depression related to diabetes.
Discuss two reasons a person with diabetes would become anxious and become emotionally distressed regarding their diabetes, and describe two ways you would try to reduce their emotional distress.
15 Presentations
Evaluation
  Each small group conducted a diabetes assessment on a person with diabetes that was of a different ethnic background than the students in their group, which included a genogram showing family members with diabetes; overview of their culture; cultural beliefs; practicesrelated to diabetes management; traditional diet; cultural views on family support systems of the particular ethnic group.
Students prepared PP slides on their diabetes assessment.
On the basis of the specific assessment data that was collected, they were required to identify 2 needs of the particular individual within that family or of the family as a whole, and discuss an intervention for each need that would promote better diabetes management in this particular cultural group, and potentially prevent diabetes complications either for the individual or family within that group. 
Abbreviations: Db: Discussion Board; PH: Public Health; DSME: Diabetes Self-Management Education; CCM: Chronic Care Model; HL: Health Literacy; NL: Numeracy Literacy; GL: General Literacy; CC: Cultural Competency; CLAS: Cultural and Linguistic Appropriate Services; ADA: American Diabetes Association; HCP: Health Care Professional; PP: Power Point.
Table 2: Sample course outline, articles and discussion board questions.