This assignment proposes a lesson plan on diabetes care, which is designed for an individual named Sophie. The session aims to improve self-management of diabetes by teaching the skill of blood glucose testing. The assignment will describe the content and context of the activity, and will explore aspects of the Social Learning Theory (Bandura, 1977) to critically analyse how the session has been designed and delivered, including evaluation. The conclusion will reflect on the knowledge gained from this analysis, and the impact it will have on future care with patients.
All names have been replaced to protect patient confidentiality in line with the Nursing and Midwifery Council (NMC, 2017) code of conduct and Data Protection Act (1998).
Description:
I have chosen to propose a teaching activity with an aim to improve an area of self-management of diabetes care, by monitoring an individual’s blood glucose levels. Type 2 diabetes is a chronic metabolic condition, which affected 3.2 million adults in the UK in 2013 (NICE, 2017). Diabetes can significantly impact the body, making diabetes care very time consuming and costly on the National Health Service; therefore self-management of individual’s diabetes is vital. One aspect of diabetes care is blood glucose level testing, which individuals should be able to do independently (Diabetes UK, no date).
The proposed teaching plan is designed for Sophie, whom is being cared for by the community mental health team for anxiety. Sophie has a diagnosis of type 2 diabetes, and has recently started medication to aid managing this. She has been advised to start testing her blood glucose levels three times a day to monitor, and adjust her diet accordingly. Sophie has anxiety and feels nervous about having to learn the skill and do it correctly. Sophie has a supportive family whom are involved in her care, thus, this session would be aimed for them as well to support Sophie with this task. This teaching proposal is planned to take place on a home visit, at a time that suits the learner and educator, lasting no longer than one hour.
Aim:
For Sophie to self-manage an area of her diabetes care by testing her blood glucose levels.
Objectives:
For Sophie and her family to:
⦁ Identify equipment needed for blood glucose testing
⦁ Demonstrate and practise a blood glucose test
⦁ Record the results correctly
The session begins by introducing the session, discussing the aims and objectives. The educator and learners will discuss and be shown the equipment needed to perform the test. A video from Diabetes UK (no date) will be shown of a blood glucose test, and learners will be able to discuss what they observed. The educator will demonstrate a blood glucose test, talking through the steps with the learners. A break will be provided, and after, learners would be required to demonstrate and practise taking their own and each other’s blood glucose levels, with the educator providing immediate feedback to ensure the learner is testing safely and effectively. Followed will be a discussion on how to record these results, and how the individual feels about performing the test.
My Analysis:
Part 1: How have I designed my teaching plan?
Learning is a process where individuals gain new knowledge or skills which may alter the way they think or feel about something, as well as their attitudes and actions (Dunning, 2013). A learning theory is a framework which describes and explains how people learn; different theorists have proposed different concepts (Braungart and Braungart, 2008). Bandura (1977) proposes the social learning theory (SLT), suggesting learning occurs by personal characteristics of the learner, behavioural patterns and the environment (Figure 1) (Braungart and Braungart, 2008). Bandura (1977) proposes different concepts of this theory, including role modelling, vicarious reinforcement and self-efficacy, which will be explored and used to design my teaching plan (Table 1).

Theory concept Description Teaching activity
Role Modelling, SLT
(Bandura, 1977) Role modelling proposes we learn skills through imitation, significantly learning from observing other’s actions and what happens to them as a result This activity is designed as an observational activity, for the learner to observe the educator display the equipment, to watch a video of blood glucose testing, and observe the educator perform a blood glucose test
Vicarious Reinforcement, SLT
(Bandura, 1977) Vicarious reinforcement is another concept of SLT, suggesting reward or punishment of role models behaviour can impact learning and reproduction of behaviour. Watching the video and educator performing the blood glucose test correctly and getting a positive result at the end, without showing signs of discomfort.
Self-Efficacy, SLT
(Bandura, 1977; Bandura, 1995) Self-efficacy refers to an individual’s belief of what they are capable of doing – capability of performing a skill which can increase the likelihood of performing the behaviour again. Learners would be required to reproduce the skill and practise testing their own blood glucose levels under supervision of the educator to improve their self-efficacy. Feedback
Table 1: A description of the theory concept and how the teaching session has been designed based on this.
This teaching session is designed as an observational activity based on SLT’s role modelling. This is designed to allow Sophie to learn the technique through observation, and internalise the technique for later recall. Learners must attend to what they are observing, and should mentally internalise this (Horsburgh and Ippolito, 2018).The literature states individuals are more inclined to imitate behaviour from those they perceive themselves similar to, and someone from a high status (Braungart and Braungart, 2008; Flynn, 2011). An educational programme by Peek et al. (2014) used individuals with diabetes to demonstrate interventions, which learners may perceive themselves more similar to than a nurse, acting as better role models. This is supported by the benefit of peer learning and observation, which Bailey-McHale and Moore (2011) describe as a powerful activity of learning. However, these interventions were related to healthy living education rather than learning a skill, therefore the role model may differ in their attributes. It could be argued a nurse with knowledge and experience could be considered as high status in diabetes care, thus an individual may perceive them as a role model to imitate behaviours from, reproducing the correct procedure.
Vicarious reinforcement in SLT adds further explanation to learning during observational activities. Performing a blood glucose test can be slightly uncomfortable, and for Sophie whom has anxiety over performing this test, it would be important the educator does not show discomfort in their facial or verbal expression to avoid negative reinforcement. This concept is supported by the Health Belief Model (Kemm, 2014), which suggests the likelihood of engaging in health promoting behaviour is influenced by the perceived benefits and barriers; thus, by reducing the perceived barriers of pain during the test, may increase the chance of reciprocating this behaviour.
Practising a skill can improve an individual’s self-efficacy about performing that skill. Bandura (1995) states performance outcomes are pivotal for improving self-efficacy; therefore Sophie should practise the skill to improve her self-efficacy. Gecas (2004) suggests self-efficacy functions as a form of self-fulfilling prophecy, which individuals perform behaviours that match their initial beliefs. This is important to note in diabetes care to ensure learners such as Sophie, whom have negative attitudes or anxieties toward blood glucose testing, are challenged in their abilities when performing this skill. Ajzen’s (1985) theory of planned behaviour supports this idea, arguing individual’s behavioural intention is determined by their attitudes, subjective norms and perceived behavioural control. This suggests practising the skill of blood glucose testing could increase the perceived behavioural control, impacting behaviour change.
What may facilitate or hinder learning?
Learning is a complex process, which can be affected by various factors including the educator myself. This teaching session is designed on the importance of a role model, thus it’s vital the educator is fully knowledgeable and competent to promote positive learning. Peek et al. (2014) found participants wanted to have faith and trust in the educator to learn the correct information. Cooper et al. (2003) found the success of diabetes education was influenced by the approach adopted by the educator which incorporated respect and integrity; humanist theories of learning reflect the importance of human interaction to facilitate learning (Maslow, 1968). Therefore, it would be important to consider the educators knowledge and approach to help facilitate further learning.
The learner themselves may also facilitate or hinder learning. The human brain requires glucose in order to function; a disruption of glucose can impact concentration, learning and memory (Kiefer, 2007; Perlmuter et al. 1984; Ryan and Geckle, 2000). These cognitive functions are optimal when blood glucose levels are stable (Dunning, 2013); therefore, this teaching session would be pivotal to carry out when Sophie’s blood glucose levels are stabilised to facilitate further learning. In addition, diabetes affects individuals from different economic and socio-cultural backgrounds, which may hinder learning. Abdulrehman et al. (2016) found economic and cultural beliefs influenced diabetes self-management, finding some cultures did not accept responsibility for self-management. Economic and socio-cultural backgrounds must be considered to work towards realistic goals for the individual.
Part 2:
Evaluation of teaching
Evaluation is an important aspect in teaching to assess whether a desired change has been achieved and to enhance the learning experience for others (Briggs and Sommefeldt, 2002). The first evaluation will be assessing whether Sophie meets the objectives of the teaching session, which can be evaluated by observation from the educator. The objectives should be assessed at different time intervals to ensure the taught skill is continuously used beyond the session. Informal evaluation helps learners feel more comfortable, which would be more appropriate for Sophie in order to reduce further anxiety (Horsburgh and Ippolito, 2018).
Evaluation occurs throughout the teaching session, but an evaluation tool can help identify areas that may need to change (Briggs and Sommefeldt, 2002). The Department of Health (DoH), National Diabetes Support Team (NDST) and Diabetes UK (2006) have developed a toolkit to evaluate diabetes education which I will use: a self-review tool (Appendix B) for the educator to evaluate their contribution to the session, and a patient evaluation tool (Appendix C) for the learner to evaluate. The aim is for the educator to review and reflect on any discrepancies between the learner and educators evaluation. These tools are designed to fulfil the NICE criteria for a diabetes education programme (NICE, 2016).
Quality measures:
In addition to evaluating my own teaching session, it’s important to measure the impact on service. Quality improvement in healthcare refers to making healthcare safe, effective, patient-centred, timely and efficient (Ham et al., 2016). An individual with diabetes visits healthcare providers on average 4 times per year, which Ham et al. (2016) identifies as 1% of a lifetime in healthcare. Therefore, diabetes education is not only important on healthcare cost but to avoid multiple contacts with healthcare providers.
My teaching plan will use the quality measure of effectiveness to demonstrate the impact it has on service improvement. In diabetes, an individual’s HbA1c levels are checked regularly to identify the average blood glucose levels (Diabetes UK, no date). These results could demonstrate whether the teaching session has impacted Sophie’s average blood glucose levels, suggesting Sophie has self-managed her diabetes effectively, requiring less contact with health care providers to check her blood glucose levels. However, as this session is teaching a skill, and not teaching how to reduce blood sugars, it may not be attributed to the cause of normal blood glucose levels. It could be argued an increased awareness of blood sugar results may impact individual behaviours, which may result in reduced blood sugars overall (Cameron et al., 2018). Furthermore, if the HbA1c results are abnormal, it could identify a route for further education.
Furthermore, diabetes can have serious complications, and is associated with serious interventions, such as foot amputations. A long term outcome measure of diabetes education could be identifying national audits on complex diabetes interventions (Diabetes UK, 2018). However, it could be difficult to identify a causal relationship between a teaching session and an outcome measures due to the time lag between them, and other possible causes and factors. Therefore, it would be appropriate to use a process measure such as HbA1c levels to measure quality and service improvement of the teaching session.
Discussion and Learning:
This assignment focussed on Social Learning Theory to propose a teaching activity I could undertake for Sophie and her family. By analysing SLT, I have reflected on the importance of role modelling, which is vital in nursing education (Horsburgh and Ippolito, 2018), where we learn various skills from other colleagues to further our development of knowledge and abilities. In addition, I have come to understand the importance of a role model we perceive ourselves similar to. I reflected on times during my nursing training where I have gained further knowledge from nurses whom take a similar approach to mine, and how this is always important to me when learning or developing a nursing skill. I have also reflected on the use of peer support workers with lived experience of mental health, and how relevant their knowledge and experience is to supporting and teaching other patients (Mind, 2013). Therapeutic relationships are essential in mental health care, which I recognise as an intervention to further develop learning opportunities through the concept of role modelling. In future practise, I aim to recognise, with a team, the most appropriate role model for that individual, allowing them to be the educator to enhance further learning opportunities through role modelling.
The role of vicarious reinforcement plays a role in learning, and is an aspect of SLT I had not considered to be important in the learning process. However, this analysis has developed my understanding, and I recognise how the simplest of response and result to the role model may actually impact learning. This teaching session teaches a skill, but for other diabetes education, I would also include life stories from individuals with diabetes. I would include both positive and negative results of self-management of diabetes, which could vicariously reinforce the learner to develop better self-management techniques, which Peek et al. (2014) has proven to be effective. Furthermore, in nursing, we act as appropriate role models to patients, families and also other colleagues, therefore the results we receive of a certain behaviour is important for others to vicariously learn from. As a result, it’s important to show the rewards we receive from such behaviours, such as going the extra mile for a patient, and how this has rewarded ourselves in our jobs, in order for others to learn from as well.
In mental health nursing, we often face individuals who have low self-efficacy, which may impact learning of new information or a new skill. It would be significant to encourage learners to practise skills to improve self-efficacy, and provide immediate feedback to facilitate further learning. In addition, by improving an individual’s self-efficacy can improve areas of an individual’s mental health (Bavojdan et al., 2011). I have developed further understanding of the role of self-efficacy in learning, and in future care and practise, when teaching an individual a new skill, whether this be a physical health skill, or something such as relaxation, by providing positive feedback and aiming to improve their beliefs about their abilities, this may demonstrate an improved learning outcome.
Conclusion:
Through analysing concepts of social learning theory, I have designed a teaching session for Sophie to improve her self-management of diabetes by learning the skill of blood glucose testing. I have explored the concept of role modelling, vicarious reinforcement and self-efficacy, gaining further understanding of how these concepts enhance further learning. In addition, aspects of the educator and learner can hinder or facilitate learning as well. Evaluation is a vital part of teaching, which informal evaluation tools can be used, as well as using a quality measure such as effectiveness, to evaluate the impact it has on service improvement. This analysis has furthered my understanding of aspects that can further an individual’s learning experience, and has provided me with ideas to take back to practise.

References:
Abdulrehman, M.S., Woith, W., Jenkins, S., Kossman, S. and Hunter, G.L., (2016) ‘Exploring cultural influences of self-management of diabetes in coastal Kenya: an ethnography.’ Global Qualitative Nursing Research, 3, p.2333393616641825.
Ajzen, I. (1985) ‘From intentions to actions: A theory of planned behavior’, In Kuhl, J. and Beckman, J. (ed.) Action-control: From cognition to behavior. Heidelberg: Springer. Pp: 11-39.
Bailey-McHale, J., and Moore, L. (2011) ‘Peer support and observation’, in Mason-Whitehead, E., Gidman, J., and McIntosh, A. (ed.) Key concepts in healthcare education. Los Angeles, Calif. SAGE, pp. 128 – 133.
Bandura, A. (1977) Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall
Bandura, A. (1995) ‘Exercise of personal and collective efficacy in changing societies’, In Bandura, A. (Ed.) Self-efficacy in changing societies (pp. 1-45). New York: Cambridge University Press
Bavojdan, M.R., Towhidi, A. and Rahmati, A. (2011) ‘The relationship between mental health and general self-efficacy beliefs, coping strategies and locus of control in male drug abusers’. Addiction & health, 3(3-4), p.111.
Braungart, M.M., and Braungart, R.G. (2008) ‘Applying Learning Theories to Healthcare Practise’, in Bastable, S. (ed.) Nurse as Educator, Principles of Teaching and Learning for Nursing Practise. Jones & Bartlett Learning, pp 63-110.
Briggs, A. R. J. and Sommefeldt, D. (2002) Managing effective learning and teaching. London: P. Chapman Pub.
Cameron, D., Harris, F., and Evans, J.M.M. (2018) ‘Self-monitoring of blood glucose in insulin treated diabetes: a multicase study’, BMJ Open Diabetes Res Care. 6(1). doi: 10.1136/bmjdrc-2018-000538
Cooper, H.C., Booth, K. and Gill, G. (2003) ‘Patients’ perspectives on diabetes health care education’, Health Education Research, 18(2), pp.191-206.
Data Protection Act (1998) c 29. Available at: https://www.legislation.gov.uk/ukpga/1998/29/introduction (Accessed on 10/11/2018)
Department of Health, National Diabetes Support Team and Diabetes UK (2006) How to Assess Structured Diabetes Education: An improvement toolkit for commissioners and local diabetes communities. Available at: https://www.changinghealth.com/uploads/2/0/3/7/20374409/99_structured_education_toolkit_2013.pdf (Accessed: 13/11/18).
Diabetes UK (no date) Diabetes and checking your blood sugars. Available at: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing (Accessed on 18/11/18)
Diabetes UK (2018) Evaluate quality improvement in diabetes care. Available at: https://www.diabetes.org.uk/resources-s3/2018-11/QualityImprovement_17Aug_Web.pdf? (Accessed on: 18/11/18)
Dunning, T. (2013) Diabetes education: art, science and evidence. Chichester, West Sussex: Wiley-Blackwell .
Flynn, S. (2011) ‘Role model’, in Mason-Whitehead, E., Gidman, J., and McIntosh, A. (ed.) Key concepts in healthcare education. Los Angeles, Calif. SAGE, pp. 167-172
Gecas, V. (2004) ‘Self-agency and the life course’, In Mortimer, J.T. & Shanahan, M.J. (Eds.), Handbook of the life course (pp. 369-390). New York: Springer Science + Business Media, LLC.
Ham, C., Berwick, D., and Dixon, J. (2016) ‘Improving quality in the English NHS. A strategy got action’. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Improving-quality-Kings-Fund-February-2016.pdf (Accessed on: 18/11/18)
Horigan, G., Davies, M., Findlay‐White, F., Chaney, D. and Coates, V., (2017) ‘Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review’, Diabetic Medicine, 34(1), pp.14-26.
Horsburgh, J. and Ippolito, K. (2018) ‘A skill to be worked at: using social learning theory to explore the process of learning from role models in clinical settings’. BMC Medical Education, 18(1), p.156.
Kemm, J. (2014) Health promotion: ideology, discipline, and specialism. OUP Oxford.
Keifer, I. (2007) ‘Brain Food’. Scientific American Mind, 18(5), pp. 58-61
Maslow, A. (1968) ‘Some educational implications of the humanistic psychologies’, Harvard Educational Review, 38(4), pp.685-696.
Mind (2013) Mental health peer support in England: Piecing together the jigsaw. Available at: https://www.mind.org.uk/media/5910954/piecing-together-the-jigsaw-full-version.pdf (Accessed on: 18/11/18)
National Institute for Health and Care Excellence (2016) Quality statement 2: structured education programmes for adults with type 2 diabetes. Available at: https://www.nice.org.uk/guidance/qs6/chapter/Quality-statement-2-Structured-education-programmes-for-adults-with-type-2-diabetes (Accessed on: 18/11/18)
National Institute for Health and Care Excellence (2017) Type 2 diabetes in adults: management. Available at: https://www.nice.org.uk/guidance/ng28/chapter/Introduction (Accessed on: 18/11/18)
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Peek, M.E., Ferguson, M.J., Roberson, T.P. and Chin, M.H. (2014) ‘Putting Theory into Practise: A Case Study of Diabetes-Related Behaviour Change Interventions on Chicago’s South Side’, Health Promotion Practise, 15(2), pp. 40 Doi: 10.1177/1524839914532292.
Perlmuter, L.C., Hakami, M.K., Hodgson-Harrington, C., Ginsberg, J., Katz, J., Singer, D.E. and Nathan, D.M. (1984). ‘Decreased cognitive function in aging non-insulin-dependent diabetic patients’. The American journal of medicine, 77(6), pp.1043-1048.
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Ryan, C.M. and Geckle, M. (2000) ‘Why is learning and memory dysfunction in Type 2 diabetes limited to older adults?’. Diabetes/Metabolism Research and Reviews, 16(5), pp.308-315.
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Appendix A:
The lesson plan I will use to teach Sophie and her family about blood glucose testing.
Aim:
For Sophie to self-manage an area of her diabetes care by testing her blood glucose levels.
Objectives:
For Sophie and her family to:
⦁ Identify equipment needed for blood glucose testing
⦁ Demonstrate and practise a blood glucose test
⦁ Record the results correctly

Content Learning Activities Resources Approx Time (mins) Learning Style
Introduction to the session, discuss aims and objectives Educator to talk to the learners through the session aims and objectives.

Ask if Sophie or her family have any questions Verbal
5 Social Learning Theory (SLT): Learners must attend to what they will be learning in order to mentally internalise this.

Discuss and show the equipment needed Ask learners what they think they need; discuss each equipment and uses of them Equipment
3
Watch video on how to test for blood sugars
Watch video; discuss what they have observed
Ensure student relaxed, practise relaxation if needed iPad video
(Diabetes UK, no date)
Relaxation exercises 5 SLT: Role modelling proposes we learn skills through imitation, significantly learning from observing other’s actions and what happens to them as a result.
Vicarious reinforcement is another concept of SLT, suggesting reward or punishment of role models behaviour can impact learning and reproduction of behaviour.
Break 5 SLT: To have regular breaks to keep the learners attention, and allow them to internalise what they have observed.
Watch educator perform blood sugar test For the learners to observe the educator perform a test;
Talk through each step;
Allow questions to be asked Equipment, equipment checklist 5 SLT: Role modelling proposes we learn skills through imitation, significantly learning from observing other’s actions and what happens to them as a result.
Vicarious reinforcement is another concept of SLT, suggesting reward or punishment of role models behaviour can impact learning and reproduction of behaviour.
Practise taking blood sugar Equipment, Equipment checklist, 10 SLT: Self-efficacy refers to an individual’s belief of what they are capable of doing – capability of performing a skill which can increase the likelihood of performing the behaviour again.
Discuss recording results Discussion on how to record the results.
Offer different ways, e.g. paper, phone app.
Mobile App
Written example record 5
Evaluation of the session Educator to discuss objectives, and observe Sophie identify equipment needed; demonstrate a blood glucose test and record the results correctly.
To give Sophie an evaluation form Evaluation tool 4: Patient Course Evaluation (DoH, NDST and Diabetes UK, 2006). 5

Appendix B:
An evaluation tool I will use to evaluate my own contribution to the teaching session (Department of Health, National Diabetes Support Team and Diabetes UK, 2006).
TOOL 1: Self Review
Part 1: The foundations of the course
Good Satis Unsat Evidence
1. To what extent is the course well-founded (that is, based on good practice, known to be effective)?
2. Is the course written down?
3. To what extent are relevant characteristics of the patients known?
4. Other (specify)
Part 2: The programme
The mechanics
Good Satis Unsat Evidence
5. To what extent have the aims and objectives of the course been clearly identified?
6. To what extent has the knowledge (facts, understandings) that the patients should acquire been identified?
7. To what extent have the skills (know-how) the patients should acquire been identified?
8. To what extent is the course broken down into a manageable, sessions?
9. To what extent has the order of presentation been identified?
10. To what extent have suitable examples to make meaning clear been identified?
11. Is it clear who will deliver the various parts of the course?
12. Is it clear when and where the course will be held?
13. To what extent is the environment where the course will be held conducive to learning?
14. To what extent are the teaching resources available and appropriate (e.g. media, materials, handouts)?
15. To what extent has provision been made for the health and safety of the patients while they are on the course?
16. Other (specify)
Teaching and learning
Good Satis Unsat Evidence
17. To what extent is your/the educator’s knowledge of diabetes management adequate for the course?
18. To what extent are your/the educator’s skills in diabetes management adequate for the course?
19. To what extent has the management of individual and group work to accommodate learning needs been planned?
20. To what extent are there regular activities spread throughout the course that support learning?
21. To what extent are there activities for patients that practise skills to an adequate level of competency?
22. To what extent are the aims/objectives made clear to the patients?
23. To what extent is the pacing of the presentations appropriate for the patients?
24. To what extent are you/the educator succinct and clear and to the point in your presentations?
25. To what extent do you/does the educator ask and answer questions that support learning appropriately?
26. To what extent are you/is the educator successful in accommodating diversity amongst patients?
27. To what extent do you/does the educator bring sessions to a successful conclusion?
28. Other (specify)
Part 3: Outcomes of the course
Good Satis Unsat Evidence
29. To what extent was the programme delivered as specified?
30. To what extent did the patients acquire the expected knowledge and skills and have relevant attitudes supported?
31. Is there a procedure for those who do not acquire the knowledge and skills or who do not complete the course?
32. Based on follow-up of the patients’ progress, to what extent do the patients manage their condition effectively?
33. Based on follow-up of the patients’ progress: to what extent does the patients’ quality of life improve?
34. Would the patients recommend the course to others?
35. Other (specify)

Appendix C:
An evaluation tool I will use to give to the learner to evaluate the teaching session (Department of Health, National Diabetes Support Team and Diabetes UK, 2006).
TOOL 4: Patient Course Evaluation
(The numbers in brackets at the end of the lines indicate the items in TOOLS 1 and 3 that the responses are likely to relate to.)
1. To what extent did you understand what the course might do for you? (22)
2. To what extent were the dates of the course convenient for you? (12)
3. To what extent was the place where the course was held comfortable? (12)
4. To what extent could you see and hear well enough? (13)
5. What about health and safety? Were you happy about that? (15)
6. How did you find the sessions? Was there too much in them? Was the order right for you? Was the information presented too quickly, too slowly or just about right for you? (8, 9, 23, 24)
7. To what extent did you understand what you had to do? (10, 19, 20-27)
8. Did you find the activities helpful? (20, 21)
9. Did you get enough practice? (21)
10. Did you find that the educator could answer your questions for you? (25)
11. Do you feel confident enough to give your new skills a try? (30)
12. Do you think it might make a difference to the quality of your life? (33)
13. Did you enjoy the course overall? (34)
14. Would you recommend the course to others? (34)
15. Any other comments e.g. suggestions for improving the course?

 
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