Health education relating to diabetes Ann MacLeod, RN, BScN, MPH.

Health education relating to diabetes

Ann MacLeod, RN, BScN, MPH

A. MacLeod. Fall 2002 2


One minute paper

Think of the last time you tried to adopt a healthier behaviour.

What motivated you to change?

What helped, what hindered?


Levels of Prevention

Primary - before a disease develops

Secondary - screening, early identification

Tertiary - preventing more serious complications from an identified condition


Stages of Change, Prochaska and DiClemente

Precontemplation

contemplation

preparation

action

maintenance


Precontemplation

“ it isn’t that they can’t see the problem, they can’t see the solution” “ I can’t be bothered trying to control my sugars.”

No intention to change behavior resistance to recognizing or modifying a

behavior


Patient and Nursing

“eating chocolate is the only pleasure I get” Patient may feel rebellion, need to share

info, demoralized, Dr will not spend time

Work on developing rapport “tell me about, …” encourage change to talk give factual, motivating information


Contemplation

“Knowing where you want to go but not quite ready”

know problem but not quite made commitment but within 6 months

weighing of pros and cons of problem, impact on others and solutions to it


Patient and Nursing

Guilt, profound ambivalence, procrastinator

here are the tools to make it easier for you provide networking “ here are the complications of uncontrolled

diabetes, but we can help you control them”


Preparation

Planning to change in next 30 days taking some small steps of cutting down

behavior, investigating some programs


Patient and Nurses

Decision to try on behavior “ I think I can control my diet, but I don’t know

how to give a needle. ”

LOC, self-efficacy, positive reinforcement, follow up visits, tools to help, iron out logistics

“how can I help?” “Can you show me how you use your glucometer and needles?”


Research studies

Researchers found that key is timing change to correct stage independent of treatment ie counselling, peer programs

for smoking success (@6mos) was - precontemplators 22% - contemplators 43% - preparation or action 76%


Action

Currently, practicing change but transition within last six months

a difficult time as takes energy but self-liberation and autonomy to change lives

“I am really working hard to change”


Patient and Nursing

Intense time with new behavior, high risk for relapse

lots of support, external recognition, follow up meetings, behavior change and long term benefits “what things are you seeing different” “ your sugars are being well controlled.”


Relapse

“tell me about what happened” “what were the elements of relapse” “reflect on what you valued to start in the

first place”


Maintenance

Work to prevent relapse and consolidate the gains beyond six months of action phase

“I may need some help right now to maintain changes”

development of alternate coping strategies


Patient and Nurses

Rewards still very important

“do you find it easier to maintain changes” “what ways to increase your activity are

working for you?” “ what are your rewards for keeping your

sugars regulated?”


Important Steps for Change

1. Clearly assess patient’s stage Nurse, “Tell me where you are at about

dealing with your diabetes.” 2. Tailor interventions accordingly


Enhancing Motivation

Elicit client’s concerns emphasize personal choice and

responsibility for future behavior treatment goals and strategies are negotiated

based on info and acceptability express and reflect client perceptions


Enhancing motivation cont’d

Positive reinforcement support continued exploration of the

problem and solutions reinforce goal identification and attainment help pt to move forward “How would like

things to turn out for you?”

Health education relating to diabetes Ann MacLeod, RN, BScN, MPH.

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