Open Access Highly Accessed Research article

Evaluation of an online interactive Diabetes Needs Assessment Tool (DNAT) versus online self-directed learning: a randomised controlled trial

Sara Schroter1*, Richard D Jenkins2, Rebecca A Playle3, Kieran M Walsh4, Courtenay Probert2, Thomas Kellner5, Gerhard Arnhofer6 and David R Owens7

Author Affiliations

1 BMJ Editorial Office, BMJ Group, BMA House, Tavistock Square, London WC1H 9JR, UK

2 BMJ onExamination, Cardiff Medicentre, Heath Park, Cardiff, CF14 4UJ, UK

3 South East Wales Trials Unit, Department of Primary Care & Public Health, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK

4 BMJ Learning, BMJ Group, BMA House, Tavistock Square, London WC1H 9JR, UK

5 AXDEV Europe, Ammerthalstr. 4 - 6, 85551 Kirchheim, Germany

6 MSD, a subsidiary of Merck & Co. Corp., Hertford Road, Hoddesdon, EN11 9BU, UK

7 Diabetes Research Unit, 1st Floor Academic Centre, University Hospital Llandough, Penlan Road, Penarth, CF64 2XX, UK

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BMC Medical Education 2011, 11:35  doi:10.1186/1472-6920-11-35

Published: 16 June 2011



Methods for the dissemination, understanding and implementation of clinical guidelines need to be examined for their effectiveness to help doctors integrate guidelines into practice. The objective of this randomised controlled trial was to evaluate the effectiveness of an interactive online Diabetes Needs Assessment Tool (DNAT) (which constructs an e-learning curriculum based on individually identified knowledge gaps), compared with self-directed e-learning of diabetes guidelines.


Health professionals were randomised to a 4-month learning period and either given access to diabetes learning modules alone (control group) or DNAT plus learning modules (intervention group). Participants completed knowledge tests before and after learning (primary outcome), and surveys to assess the acceptability of the learning and changes to clinical practice (secondary outcomes).


Sixty four percent (677/1054) of participants completed both knowledge tests. The proportion of nurses (5.4%) was too small for meaningful analysis so they were excluded. For the 650 doctors completing both tests, mean (SD) knowledge scores increased from 47.4% (12.6) to 66.8% (11.5) [intervention group (n = 321, 64%)] and 47.3% (12.9) to 67.8% (10.8) [control group (n = 329, 66%)], (ANCOVA p = 0.186). Both groups were satisfied with the usability and usefulness of the learning materials. Seventy seven percent (218/284) of the intervention group reported combining the DNAT with the recommended reading materials was "very useful"/"useful". The majority in both groups (184/287, 64.1% intervention group and 206/299, 68.9% control group) [95% CI for the difference (-2.8 to 12.4)] reported integrating the learning into their clinical practice.


Both groups experienced a similar and significant improvement in knowledge. The learning materials were acceptable and participants incorporated the acquired knowledge into practice.

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