Person centered methods in group based diabetes education

Self-management behavior in persons with type 2 diabetes (T2DM) is crucial to prevent diabetes complications, improving diabetes outcomes and quality of life. Person-centeredness is a key element in diabetes self-management education and support because it encourages behavior changes, creates a sense of empowerment, and maximizes quality of life (1). 

Although many HCPs support the concept of person-centeredness, its implementation in practice remains challenging. HCPs often rely on teaching methods related to informing, directing, and making choices on behalf of patients. However, these skills have shown to limited impact on self-management (2). 

Most research-based person-centered methods address communication between HCPs and persons with T2DM in individual consultations. However, group-based diabetes education is a widespread method of support; it may be more cost-effective than individual education and brings patients together to share experiences (3). Moving towards person-centeredness in group-based diabetes education involves a balance between education related to self-management, addressing psychosocial needs, and managing group processes. 

Aim of the study
To investigate, develop and test approaches that support HCPs in facilitating person-centeredness in group-based diabetes education and support targeting persons with T2DM.

Design and methods
The research project is inspired by action research design (4). This approach is a useful method for changing clinical practice by involving HCPs and persons with T2DM in the process of change consists of three different phases including problem-finding, problem-solving and solution-testing (5).

Problem-finding:
The aim of the first phase is to investigate HCPs approaches that support or hinder person-centeredness in existing group-based diabetes programs targeting persons with T2DM.
Method:
1. Muliti-sited ethnographic field work of group-based diabetes programs over five weeks in a municipal and a hospital setting. The programs included 21 persons with T2DM and 10 HCPs. 
2. 10 in-depth semi-structured interviews with persons with T2DM and HCPs.

Problem-solving:
Develop and prioritize approaches that support HCPs in facilitating person-centeredness in group-based diabetes education and support.
Method:
Three interactive and innovative workshops in collaboration with an interdisciplinary team consisting of 14 HCPs experienced in diabetes education. They were recruited from five different settings. 

Solution-testing:
Methods based on person-centered principles supporting HCPs competencies in addressing person-centeredness will be tested by HCPs in their own practice. 
Method:
1. Ethnographic field observations of the intervention.
2. Focus groups and semi-structured interviews with 20 persons with T2DM after attending in the intervention. Additionally, three in-depth interviews with HCPs providing the intervention.


Target groups
The research project targets persons with T2DM attending group-based diabetes self-management programs as well as the HCPs providing the programs.

Collaborators
Health Promotion Research, Steno Diabetes Center, Denmark
Department of Nursing, Metropolitan University College, Denmark
Department of Public Health, University of Copenhagen, Denmark

Inspirational publications
  1. Haas L et al. National standards for diabetes self-management education and support. Diabetes Care 2014;37 Suppl 1:S144-53.
  2. Anderson RM, Funnell MM. Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns 2005;57:153-7.
  3. Due-Christensen M et al. Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control? Diabet Med 2012;29:251-6.
  4. Coghlan D, Brannick T (2001) Doing Action Research – in Your Own Organization. SAGE Publications, London, Thousand Oaks.
  5. Voigt JR et al. Action research as a method for changing patient education practice in a clinical diabetes setting. Action Research 2014; 0(0) 1–22.

Sidst opdateret 30-11-2016

Responsible

Vibeke Stenov
Diabetes Management Research

E-mail vbse@steno.dk
Phone +45 30 75 22 31