follow-up. The secondary endpoint was change in the degree of retinopathy. There were no significant differences between the two groups. Data did not involve the possibility that a patient for instance could have worsening at the right eye, and at the same time improved on the left eye. To comply with this approach a score system was made to find the overall changes in retinopathy (figure 1). Overall both groups improved. The themes found in the focus group interviews were nearly identical, but the weighting and description of the themes were different (figure 2). Fear of blindness was the only theme described identical at the time of diagnosis. Fear was as a chock and as the anxiety to lose sight. The main theme in the two groups differed. “Knowledge” was the most significant theme in the intervention group. Knowledge on retinopathy was described as important in everyday life. This was indicated as motivation for metabolic control and treatment of hypertension. The main theme in the control group was “Responsibility for prevention”. Responsibility should be handled by professionals and they themselves had only a minimum of responsibility for the prevention of retinopathy. The control group indicated that they had knowledge, but they did not act according to the knowledge. When the professionals took responsibility, the patients felt safe, but it did not reduce their fear of blindness. Both groups described “accept”, but in different ways. Characteristic of the two groups were that the control group was resigned. They felt only a minimum responsibility for preventing retinopathy and did not know how to use their knowledge. In contrast the intervention group took action and responsibility in the prevention showed as shared care. The study has illustrated the need for patient education in relation to retinopathy and the need for constantly developing new nursing practices to support and meet the needs of the patients. Our interview findings showed that patient education has an impact on fear of blindness. The interviews findings confirm that knowledge on diabetes and retinopathy as well as openness to the psychological dimension of retinopathy strengthens the patient sense of coherence resulting in less fear or anxieties (7). Moreover, the interviews findings illustrated that knowledge on retinopathy, self-care, and self-efficacy in relation to retinopathy are associated to responsibility and motivation to prevention of diabetic complications. Contrary our quantitative data did not show any significant effect of the education program. Thus, no significant differences where found between the two groups in relation to prevention or progression in retinopathy. Furthermore, no differences were found in the most important parameters (Hba1c and Blood pressure) associated with development and progression of retinopathy (8,9). Education had a positive effect on sense of coherence, empowerment, self-care and self-efficacy in relation to responsibility, ownership and everyday life with diabetes and retinopathy. The main point in this study might be that knowledge achieved by 16
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