Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-55

Health coaching has proven to be a valuable adjunct in the repertoire of support systems. Please refer to Chapter 2: Foundations of Diabetes Self-Management Education and Support for a more extensive discussion as to the process and important factors involved in health coaching. In recent years, there has been a multitude of peer supporters and peer support groups which have demonstrated success in supporting the person with diabetes (132-134). It is recognized that diabetes self-management education is effective in improving clinical outcomes, but to maintain and enhance these outcomes ongoing support is required (112,119,134). The question as to who should be providing this ongoing support has aroused considerable discussion. The PRISM study is a randomized controlled trial designed to determine who can be most effective in helping patients maintain/improve clinical and behaviour outcomes (134). The authors concluded that the role of the educator is critical, but other agents can be used if trained appropriately (134). Several strategies that have had positive outcomes when used in peer support programs include (112,134): • Self-directed behavioural goal setting.

• Problem solving. • Social support. • Patient-centered communication. • Exploration of feelings.

These peer support programs have been offered in a variety of settings using different modes of interaction. One of the most widely implemented programs is the Chronic Disease Self Management Program originated by Kate Lorig at Stanford University (132). Peer leaders are taught to use behavioural goal-setting, problem-solving and other skills to facilitate a six-week scripted course. The focus is on improving patient self-efficacy which, in turn, leads to a greater motivation to engage in positive self-management behaviours (113,135). This and other programs, such as the Project Dulce (136), have had considerable success when implemented in culturally specific communities. Face-to-face support groups, on-line groups, peer partners, peer coaches, web-based and internet accessible peer programs have all been offered with varying degrees of success (135). Further research into which “strategies can be most effectively implemented by peer supporters and how these should be offered will provide for greater insight and future direction”. At the present time, it is true to say that the availability of