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Navigating Adult Patient Empowerment thru Educational Strategies

Diabetes Educators on the diabetes health care team play an important, albeit underutilized, role in the care of patients with diabetes. The most optimistic estimate is that less than 30% of diabetic patients receive any diabetes education at all despite the fact that diabetes is increasing in prevalence worldwide. In particular, type 2 diabetes has reached epidemic proportions over the last several decades. The 2008 National Nutrition Health Survey reported a nationwide prevalence of 4.8% based on fasting blood sugar alone. Worldwide, the International Diabetes Federation estimated the global prevalence as 6.6%.

In response to the emerging global diabetes epidemic, health educators are searching for new and better education tools to help people make positive behavior changes to successfully prevent or manage diabetes. As we continue to discover the complex metabolic processes that lead to Type 2 Diabetes Mellitus (T2DM), it is important to translate the research into ordinary language so that patients can fully understand the disease and the therapies that affect the condition.

Diabetes education is fundamentally based on comprehensive assessment of the patient’s needs. News that one is already diabetic will not make the patient happy, but it will arm him or her with the understanding of the essential nature of the disease so that one can be prepared to manage it. Newly diagnosed people with T2DM need to start their journey with diabetes feeling empowered rather than downtrodden as they cope with the disease. The assessment should also include the social, cultural, religious environment, as well as an understanding of the patient’s literacy and willingness to participate in an educational program.

Using a learning needs assessment, diabetes educators can develop individualized educational plans to address patients’ identified priorities while respecting their learning style. Using principle of adult learning, the educational process should be patient-directed, problem-oriented and relevant to their lives.

The Adult Learning Theory was developed in the 1950’s, when Malcolm Knowles resurrected the concept of andragogy, or the science of adult learning, and applied it to informal adult education. His development of a conceptual basis for adult learning was built on the premise that adults learn differently than do children and have specific learning needs based on particular characteristics gained through life experiences.

Knowles’ work became widely adopted and helped shift educators away from “educating” adults toward “facilitated learning”. Subsequent research has built on this work, bringing to bear the importance creating a positive, respectful, nonjudgmental, safe, engaging, and fun environment for optimal outcomes in adult learning. Patient’s psychological status affects their learning. Denial, depression and anxiety can affect the willingness or the ability to learn and participate in their care. The Prochaska’s Transtheoretical Model shows that understanding a person’s stage of readiness for change helps predict whether interventions and learning will be effective motivators.

Diabetes education is a process, not an event. Diabetic patients should understand that diabetes is a progressive disease and therefore needs ongoing, progressive education. Diabetes educators should explain about the progressive loss of insulin producing beta cells of the pancreas regardless of therapy and that insulin should be used as another therapy option and not a failure on part of the patients.

Patients’ education must be paced learning through four sessions of successive, need-to┬Čknow content in order to address self-management skill training as they occur. Adequate time between sessions for practice and experience based on new knowledge should be devoted as well. Likewise, positive reinforcement and confidence-building through review of blood glucose records, food records and progress toward goals is essential since most adult patients with diabetes are empowered when given clear goals for blood glucose and blood pressure. Patients cannot be expected to assist with achievement of goals if they are not given the measurements and objectives that we hope they achieve.

Patients’ family members and significant others are encouraged to participate in all education sessions. Group sessions and learning activities encourage peer interaction and sharing. One of the newest innovations is the Diabetes Conversation Maps. “These are new tools to engage adult learners in making behaviour changes needed for better health. Compared to the traditional education methods, Conversation Map” sessions focus on participant-directed discussions and shared problem-solving in diabetes self-care topics, such as troubleshooting of blood glucose levels and maintaining motivation for healthy eating and physical activity. Teaching tips and techniques encourage educators to listen to and acknowledge patient concerns and to introduce alternatives and choices.

This new learner-driven education tool provides guided discussion that gives space for patients to express feelings and concerns. DIABETES CONVERSATION MAP is a visual tool that utilizes analogies to help patients better understand what diabetes is all about. An example of which is the analogy of using the “KEY” as the “INSULIN” that opens the door to the cell to let glucose inside.

In summary, diabetes educators should plan the education process (whether individual or group) around several simple, yet important messages that promote patient involvement, improve control and improve outcomes.

Consequently, we, as diabetes educators can enhance the patients’ ability to influence their own lives by helping them learn how to make informed choices about the care of their diabetes. By doing so, we will set them on a course of EMPOWERMENT so that they can responsibly manage their own condition.

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