Link to video material (in Nepali): https://www.youtube.com/watch?v=-SSCntF0BvA  

We play this video programme in our hospital waiting area while patients wait for their appointments. 

Link to video material (in English-1): https://www.youtube.com/watch?v=l0TjFas1bGA

Link to video material (in English-2): https://www.youtube.com/watch?v=AJhTJjIKVOM

We have been using the video training programme to train patients attending diabetic centre. Since 2018, 48,461 out of 53,225 patients (91%) have been tested for eye changes, including 25,255 patients since 2021. If these patients had not had their eyes photographed, they would have been at a much greater (60-90%) risk of blindness. Before we started this program in 2018, only about 28% of patients would have their eyes tested for diabetic eye disease. This programme has therefore played a significant role in helping our patients preserve their sight. We have been also delivering this awareness programme regularly to our patients including their attendees while they wait to be seen by the doctor in the outpatient department waiting area. This has hugely improved consultation efficiency by 40%, allowing our clinicians spend more time on personalized care rather than repeating standard explanations over and over.

In 2024, we launched a community education programme using video-based diabetes resources developed by the Vision and Eye Research Institute of Anglia Ruskin University, UK to support people living in rural areas, who have poor access to healthcare services. The initiative aims to help individuals understand better about diabetes and its eye complications and self-care their diabetes more effectively while also engaging non-diabetic family members so they can better support their loved ones. Participants also get their blood sugar, blood pressure, height, weight measured as part of the initiative. The programme has already been delivered across 73 villages in the Gandaki Province, reaching 4,325 participants. The programme was highly effective in improving diabetes knowledge in participants as evidence by the following improvements: 

Question	Before workshop	After three months
Is diabetes a serious disease?	33.8% said yes	91.0% said yes
What is the recommended weekly duration of physical activity?	1.5% said at least 150 minutes per week	95.4% said at least 150 minutes per week
Does a diabetic eye examination is different from a routine eye test?	9.6% said yes	67.8% said yes
Should you go for diabetic eye screening even in the absence of visual symptoms?	12.7% said yes	99.7% said yes

 

Before attending the workshop, nearly 83% of diabetic patients reported they had never undergone an eye examination for diabetic changes. Three months after receiving the video-based education, 76% reported that they had since attended a diabetic eye examination. Among them, 65.5% were informed by eye specialists that early signs of diabetic eye disease were already present and were managed and advised appropriately, hence reducing the risk of further vision loss and blindness.

In 2018, we invited Professor Pardhan and her team to a brainstorming workshop to lead the development of a training material for diabetic patients. Participants included representatives of the Diabetes and Endocrinology Association of Nepal (DEAN), Nepal Health Research Council, diabetic patients, and healthcare providers including a diabetes doctors, dietician, ophthalmologists, a physical activity instructor, and a behaviour change worker. Diabetes-awareness training, culturally appropriate to the Nepali context, was developed in the local language, to address the barriers identified by her research. 

The program was validated in Nepali patients using a randomised controlled trial, which has been published in a peer-reviewed journal (Pardhan, Upadhyaya, Smith, Sharma, Tuladhar, Adhikari, Kidd, & Sapkota, 2023. Front Endocrinol, 14, 1076253).

In addition, we have trained primary healthcare volunteers in those villages to become “diabetes community champions” so that they are able to provide basic education and guidance on diabetes, including diabetes-related eye complications, the importance of attending diabetic eye check-ups, and to support people within their local communities, helping to promote long-term sustainability of the programme. To date, the programme has trained 71 health care volunteers ad community champions.

(i) Pardhan, S., Upadhyaya, T., Smith, L., Sharma, T., Tuladhar, S., Adhikari, B., Kidd, J., & Sapkota, R. (2023). Individual patient-centered target-driven intervention to improve clinical outcomes of diabetes, health literacy, and self-care practices in Nepal: A randomized controlled trial. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.1076253

(ii). Sapkota, R., van der Linde, I., Grunwald, I. Q., Upadhyaya, T., Lamichhane, N. and Pardhan S. (2023). The impact of stimulus configuration on visual short-term memory decline in normal aging and mild cognitive impairment, Brain Behav. Available at: https://doi.org/10.1002/brb3.3113

(iii) Pardhan, S., Islam, M. S., López-Sánchez, G. F., Upadhyaya, T., Sapkota, R. P., 2021. Self-isolation negatively impacts self-management of diabetes during the coronavirus (COVID-19) pandemic. Diabetology & Metabolic Syndrome, 13 (1), pp. 123. doi: 10.1186/s13098-021-00734-4.

(iv) Sapkota, R. P., Upadhyaya, T., Gurung, G., Parker, M., Raman, R., Pardhan, S., 2018. Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Research and Care, 6(1). doi: 10.1136/bmjdrc-2018-000525.

(v). Sapkota, R., Van Der Linde, I., Lamichhane, N., Upadhyaya, T., Pardhan, S. (2017). Patients with mild cognitive impairment show lower visual short-term memory performance in feature binding tasks. Dementia and Geriatric Cognitive Disorders Extra, 7(1), pp. 74-86. doi: 10.1159/000455831 

(i) Pardhan S, Upadhyaya T, Biswas A, Raman R, Sapkota R. Poor control of diabetes is associated with sight threatening retinopathy in patients attending tertiary care eye clinics in Nepal and India. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1085.

(ii) Sapkota R, Upadhyaya T, Gurung G, Biswas A, Durgasri J, Raman R, Pardhan S, (2017). Clinical and non-clinical factors predicting retinopathy severity in patients attending three different diabetic eye clinics in India and Nepal. The Association of Research in Visio and Ophthalmology, Baltimore, MD, May 7-11, 2017. Investigative Ophthalmology & Visual Science, 58, 70.