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J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-2819
10.4103/jfmpc.jfmpc_1406_23
Commentary
Empowering patients: Harnessing mnemonics for non-communicable disease management
Das Subhashree
Pal Debkumar
Kiran Swosti
RoyChowdhury Arka
Taywade Manish
Patro Binod Kumar
Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
Address for correspondence: Dr. Manish Taywade, Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar - 751 019, Odisha, India. E-mail: drmanishtaywade@gmail.com
8 2024
26 7 2024
13 8 28192822
25 8 2023
25 9 2023
17 1 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Building a healthy nation: A white paper on Olympic sports and the Indian education systemABSTRACT

The epidemiological transition caused a significant non-communicable disease burden in all countries, including India. It can be tackled appropriately by integrating pharmacological and non-pharmacological interventions. The outcome of the disease or control status related to the disease condition depends significantly on patient education. Mnemonics is already an accepted way of improving cognition. The newer learning theories talk about different types of mnemonics and their role in imparting knowledge. We developed three mnemonics regarding essential information related to hypertension, diabetes mellitus, and obesity. It will help achieve better control status in those diseases by improving cognition.

Diabetes
hypertension
learning theory
mnemonics
patient care
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pmcIntroduction

The epidemiological transition is attributed to the substantial burden of morbidity and mortality from non-communicable diseases (NCDs).[1] Diabetes mellitus and hypertension are some of the most common NCDs causing morbidity and mortality in India.[2] Obesity is a significant risk factor for NCDs such as cancer, diabetes, and stroke. India may be considered one of the epicenters of the epidemic of diabetes mellitus. Diabetes mellitus, hypertension, and obesity have become significant public health and economic issues due to the alarming rise in their incidence worldwide and in India.[3] In 2013, the World Health Organization developed goals for the prevention and control of non-diseases by 2025, which included reducing non-communicable disease mortality by 25 percent, halting the rise of diabetes and obesity, and ensuring that at least 80 percent of patients have access to affordable and essential medicines and key technologies for NCDs. The Sustainable Development Goals also include a target to reduce the proportion of premature deaths from NCDs, including diabetes, by one-third by 2030.[4] India’s 2017 National Health Policy aims to increase diabetes screening and treatment by 80% and reduce premature deaths from diabetes by 25% by 2025.[5]

Rationale of mnemonics in NCD

The pharmacological management in NCDs should be supported with different non-pharmacological management for achieving treatment goals. Health literacy contributes significantly to compliance with both pharmacological and non-pharmacological management.[6] The patient’s knowledge regarding the disease, its management, and its complications are significant determinants for achieving the control status of the disease. Patient education can be achieved through imparting knowledge by healthcare workers. The contact time with patients for imparting knowledge differs significantly depending on different healthcare facility levels. So, an effective communication strategy is crucial for improving patient education. Existing literature acknowledges that health programs have a significant role in improving self care management. The patients generally have their ideas, concerns, and expectations during the hospital or clinic visits.[5] The patients gather information about the disease and health events from friends, peer groups, relatives, family, and other media like newspapers, television, and movies. The role of health professionals is to validate the gathered information by the patients and guide them accordingly. The patients should retain the information received in the ways mentioned above and act accordingly.

Theory related to mnemonics in health

The social cognitive theory discusses the interaction of knowledge and patient behavior. The knowledge should improve patients’ self-efficacy, leading to a change in behavior. The cognitive function of the patients plays a crucial role in achieving self-efficacy. Traditional learning requires more duration of time for adequate cognition among patients.[6] Constructivism and cognitive psychology discuss the importance of different methods of increasing cognitive power by learning.[6] The learner should develop a retaining capacity of the information for improving cognition, followed by a reflection on the psychomotor aspect.[7] The contemporary model of education tells that if any information is given in a specific structured way, like in the form of specific repetition patterns, linguistic mnemonics, and acronyms. Different triggers include cognitive–linguistic mnemonic triggers, Strict constructivist mnemonic triggers, Narrative–constructivist mnemonic triggers, and Phonological mnemonic triggers facilitate cognition.[8] Mnemonics, either in rhyme, acronym, or short phases, can effectively impart knowledge. For example, in the first year medical student learn the carpal bone ossification with the help of mnemonic such as “She Looks Too Pretty, Try To Catch Her.” The “VIBGYOR” acronym is already well established in quickly remembering the rainbow’s colors. One of the authors developed one poem on anemia with rhyme for an easy understanding of the signs and symptoms of anemia among undergraduate students.[9] Two of the authors also formulated a mnemonic named A to Z for MBBS students for easy understanding of the job responsibilities of different community health care workers (Accredited Social Health Activists, Auxiliary Nurse Midwifery, and Anganwadi Workers). Earlier studies also reported the effectiveness of CARE (C: Check understanding, A: Adapt education, R: Reassess comprehension, E: Edoc or paper documentation) mnemonic in patient care.[10] Similar mnemonics are developed for medical education and patient care and tested for effectiveness.[11121314] GATHER (Greet, Ask, Tell, Help, Explain, and Return) is a commonly used mnemonic helping many healthcare professionals working on family planning. Similarly, educational efforts can be simplified with the help of mnemonics during patient education.

Mnemonics in hypertension, diabetes, and obesity

We have developed one mnemonic each for hypertension, diabetes, and obesity for patient education. We designed these mnemonics after an extensive literature review regarding these three morbidities regarding control status, treatment, and complications. The mnemonics will help patients to recall and improve their self-efficacy in a better way about the diseases. This mnemonic will also help healthcare providers remember health education components for patients with hypertension, diabetes, and obesity. The patients of diabetes mellitus should have a desire to reverse diabetes with the usage of appropriate diet and drugs. The patients should get help from healthcare providers to overcome addiction and depression whenever required. The patients should be aware of proper usage of insulin with avoidance of behaviors attributed to type A personality. A stress-free environment is necessary for patients with continuation of treatment. Timely testing is required with knowledge regarding control targets for better management of diabetes [Table 1].

Table 1 The “diabetes” mnemonic and its elaboration

Abbreviation letter	Elaboration of abbreviation	
D	Desire to reverse type 2 diabetes mellitus	
	Diet, Drugs: anti-diabetic drugs and deaddiction, depression	
I	Injectables: insulin (if drugs do not work or with drugs)	
A	Acceptance of diabetes and awareness of diabetes	
B	Behavior change communication: type A personality	
E	Exercise, physical activity, and eat plenty of vegetables/fruits/salads.	
	Excitement to achieve the target goals for type 2 DM	
T	Timely testing and monitoring of blood glucose and other relevant test	
	Treatment continuation until suggested by a medical practitioner	
E	Education and empowerment of people with diabetes and excitement to control	
S	Stress-free home, office, and environment (life)	
	Sleep adequate and sound sleep	
	Select any hobbies to keep yourself busy and active	

Patients with hypertension should consume adequate amounts of vegetables, fruits, and salad. There is a significant role of yoga, meditation, and exercise in the management of hypertension with regular monitoring of blood pressure using standardized devices. Avoidance of tobacco, stress, and alcohol Should be advocated in hypertensive patients with knowledge regarding risk factors [Table 2].

Table 2 The “hypertension” mnemonic and its elaboration

Abbreviation letter	Elaboration of abbreviation	
H	High consumption of vegetables, fruit/vegetables, and salad in the diet	
Y	Yoga and meditation in life	
P	Blood pressure monitoring with the appropriate device	
E	Exercise is the best medicine/drug.	
R	Reduced salt intake by cutting down foods with excessive salts such as “somasa/kachori/namkeen/Achar,” etc.	
T	Timely treatment and medicine	
E	Education and empowerment about hypertension	
N	No to tobacco/smoking and other tobacco products	
S	Stress-free, home/office life, or stress management.	
	Sleep adequately and soundly; select any hobbies to keep yourself busy and active.	
I	Increased physical activity	
O	Obesity management/slim-like smart television	
N	No to alcohol	

Patients with obesity should focus on calorie restriction with adequate physical activity. The parameters regarding obesity should be measured using standardized instruments and procedures in regular follow-ups. Life should be stress-free with a sufficient amount of sleep and the incorporation of hobbies wherever required. Patients should undergo biochemical testing with pharmacological intervention if needed [Table 3].

Table 3 The “obesity” mnemonic and its elaboration

Abbreviation letter	Elaboration of abbreviation	
O	Overall calorie restriction in outdoor activities needs to increase	
B	Body parameters like body mass index, waist circumference, and waist-hip ratio must be monitored and kept within normal ranges	
E	Exercise is the best medicine. Therefore, it should be part of routine life	
S	Stress-free home, office, and environment (life)	
	Sleep adequate and sound sleep	
	Select any hobbies to keep yourself busy and active	
I	Intervention by family members and physicians for weight reduction	
T	Testing the parameters like lipid profiles, testing/monitoring the weight on a regular interval	
Y	Yoga, meditation, and healthy eating habits	

Limitation

Mnemonics will work if the patient has the required health literacy and cognition power. However, many patients suffering from NCDs may have lower levels of cognition, leading to a poor understanding of mnemonics. Even physicians should be trained adequately to implement mnemonics in patient care successfully.

Strength

Better management of diabetes, hypertension, and obesity begins with the proper knowledge of instructions based on the patient’s needs. The mnemonics help patients arrange, differentiate, and move toward the objective that leads to changes that will give self-confidence, improve quality of life, and manage complications.

Conclusion

The mnemonic is delivered during the patient consultation and education, considering the patient’s learning style, need, and health literacy level. Contemporary learning theories talk` about different approaches to early cognitive improvement. Mnemonics have already been found to be helpful in patients’ care. The mnemonics developed by authors are expected to improve patient outcomes through better control status. Further studies are required to determine these mnemonics’ efficacy in patient education and care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest
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