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Cited by 35Celiac Disease Research and ManagementDiabetes Management and EducationInnovations in Medical Education

Online education for gluten‐free diet teaching: Development and usability testing of an e‐learning module for children with concurrent celiac disease and type 1 diabetes

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Connan, Veronik, Marcon, Margaret A., Mahmud, Farid H., Assor, Esther, Martincevic, Inez, Bandsma, Robert H., Vresk, Laura, Walsh, Catharine M.·2019·Pediatric Diabetes
DOI 10.1111/pedi.12815
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Abstract

BACKGROUND AND OBJECTIVE: Celiac disease (CD), the most common genetically-based food intolerance, affects 3% to 16% of children with type 1 diabetes (T1D). Treatment involves lifelong adherence to a gluten-free diet (GFD). Individualized dietary education is resource-intensive. We, therefore, sought to develop and test the usability of an e-learning module aimed at educating patients and caregivers regarding implementation of the GFD in children with concurrent CD and T1D. METHODS: An interactive e-learning module was developed based on extensive review of CD, T1D, and educational literature. A mixed-methods usability testing approach was used to refine and evaluate the module, using qualitative semi-structured interviews, observations, and satisfaction and knowledge questionnaires in two iterative cycles. The module was refined based on themes identified from each usability cycle. RESULTS: Eighteen patients (8 in cycle 1, 10 in cycle 2) and 15 caregivers (7 in cycle 1, 8 in cycle 2) participated. Patient participants had CD and T1D for a mean (SD) of 6.1 ± 5.1 and 8.3 ± 5.5 years, respectively. Their mean age was 13.5 ± 4.5 years. Thematic analysis of usability interviews showed the module to be appealing and resulted in minor module revisions after each cycle to improve usability. Mean satisfaction scores post-module completion were high (4.67 ± 0.54), indicating participants were "very satisfied" with the education. Knowledge test scores increased significantly from pre- to post-module completion (P = 0.001). CONCLUSION: A multifaceted user-centered usability approach demonstrated that an innovative, interactive e-learning module is effective in knowledge retention and can provide comprehensive and accessible information in the implementation of the GFD teaching in children with CD and T1D.

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  • An RCT by Connan et al. found an improvement in knowledge about coeliac disease by introducing interactive E-learning methods.

    “Another RCT by Connan et al. prospectively studied a small number of participants (n=33) and found an improvement in knowledge about CD by introducing interactive E-learning methods (19).”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [19]

    Section 3.2 reports a significant increase in knowledge scores after the interactive module, and Section 3.1 reports 18 patients and 15 caregivers (33 participants). But Sections 2.3–2.4 describe usability testing with pre- and post-module scores, not a randomized controlled trial; the RCT designation is unsupported. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • An interactive e-learning module was effective in delivering comprehensive and accessible information regarding the implementation of the gluten-free diet in children with coeliac disease.

    “An interactive e-learning module proved to be effective in delivering comprehensive and accessible information regarding the implementation of the GFD in children with CD (128).”

    From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [128]

    The Conclusions (page not provided) say the interactive module was refined to provide trustworthy, comprehensive, accessible information, and §3.2 reports improved knowledge scores overall. But the paper describes usability testing and says the module *could* provide that information; “proved effective” overstates its conclusion. The studied children also had both coeliac disease and type 1 diabetes, rather than coeliac disease alone. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Knowledge about the disease may be provided using different tools, including information leaflets, web-based documentation, or E-learnings.

    “Knowledge about the disease may be provided using different tools, including information leaflets, web-based documentation, or E-learnings (19, 147).”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [19]

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Cited by

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Authors
Connan, V., Marcon, M. A., Mahmud, F. H., Assor, E., Martincevic, I., Bandsma, R. H., Vresk, L., & Walsh, C. M.
Affiliations
  • Hospital for Sick Children (CA)
  • University of Toronto (CA)
Corresponding author
Walsh, Catharine M.
ORCID
Venue
Pediatric Diabetes
Publisher
Wiley
Published
2019-02-10
Volume
20
Issue
3
Pages
293-303
ISSN
  • 1399-543X (ISSN-L)
  • 1399-5448
DOI
10.1111/pedi.12815
OpenAlex
W2910101217
Cited by
35
References
6
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 10 · 2021: 4 · 2020: 4 · 2019: 2
FWCI
4.56
Type
journal article
Language
en
Open access
Licence
Locations
  • Pediatric Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Child Health Clinician Scientist Program
  • University of Toronto
  • Hospital for Sick Children
Topics
  • Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
celiac disease, type 1 diabetes, gluten-free diet, nutrition education, online learning modules, usability testing, children, caregivers, patient education, knowledge retention, user-centered design
MeSH terms
Adolescent, Celiac Disease, Child, Child, Preschool, Computer-Assisted Instruction, Diabetes Mellitus, Type 1, Female, Humans, Male, Patient Education as Topic, Surveys and Questionnaires, User-Computer Interface, Case-Control Studies, Caregivers, Patient Satisfaction, Education, Distance, Internet, Diet, Gluten-Free, Young Adult

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