title: Self-management support in patients with adrenal insufficiency.
abstract: OBJECTIVE
  Patient education is an important intervention to prevent an adrenal crisis in patients with adrenal insufficiency. The objective of this study was to assess the knowledge of adjusting the dose of glucocorticoids in special circumstances in patients with adrenal insufficiency who had previously been educated on this topic. In patients with insufficient knowledge, we tried to identify the underlying causes and care needs.
  
  
  METHODS
  Quantitative and qualitative study.
  
  
  METHODS
  Adult patients with chronic primary and secondary adrenal insufficiency who received glucocorticoid stress management education were invited to participate in a telephone interview in which we tested their knowledge using hypothetical situations of physical and mental stress. In respondents with insufficient knowledge, we conducted a qualitative semistructured interview to elicit the underlying reasons from patients' perspective for their lack of knowledge and determine their care needs.
  
  
  RESULTS
  Forty-three of the 83 patients who previously received education had insufficient knowledge about how to act during stressful situations. We found a significant association between education level and level of knowledge after the educational consult. The following underlying factors were identified: unawareness of the seriousness of their condition, ineffective coping strategies, the lack of experience with self-management skills and misconceptions. The most important care needs were repetition of education, the use of guidelines, learning from experience and optimizing social support.
  
  
  CONCLUSIONS
  One or two educational consults are not effective to achieve adequate self-management skills. There is a need for structural follow-up where education is repeated and practical implementation of this knowledge is tested in order to identify the potential inadequate action.
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, The Netherlands. n.t.m.mey@umcutrecht.nl.
authors.forename: Nick T M
authors.initials: NT
authors.lastname: van der Meij
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, The Netherlands.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: van Leeuwaarde
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, The Netherlands.
authors.forename: Sigrid C J M
authors.initials: SC
authors.lastname: Vervoort
authors.affiliation: Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, The Netherlands.
authors.forename: Pierre M J
authors.initials: PM
authors.lastname: Zelissen
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy*; D000328:Adult; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007407:Interviews as Topic; D010353:Patient Education as Topic / Q000592:standards; D012648:Self Care / Q000592:standards*; D013315:Stress, Psychological / Q000517:prevention & control
chemical_list: D005938:Glucocorticoids