Nurse-Talk Ratios as a Measure of Participation in a Cognitive Rehabilitation Intervention for People With Type 2 Diabetes.

Background: Comprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done.

Purpose: The purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory.

Methods: Nineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios.

Results: Talk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable.

Implications for practice: Talk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.