Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-15

COMPLIANCE VS. EMPOWERMENT

In diabetes self-management, the empowerment approach to care and education has gained widespread support among educators. It has become a hallmark of all chronic disease management models being widely implemented, as provincial and/or managed care organizations attempt to develop strategies that help society and patients cope effectively with the growing and chronic burden of diabetes (26,39-42). Traditionally, individual education programs were usually based on a compliance model of care where a patient is expected to follow a prescription supplied by a health-care provider (43). In the same way, diabetes education was typically organized around structured content designed by an expert provider and delivered using didactic teaching methods. The compliance model is based on the principle that the health-care provider is responsible for a patient’s health choices, and the patient is responsible for following the health-care provider’s recommendations and/or decisions. It has since become obvious that people do not necessarily act, learn or change their behaviour simply because a health professional prescribes a therapy. Actual behaviour change is much more complex, and the self-care behaviours associated with chronic conditions, such as diabetes, are even more so (10,12). Not only are self-care prescriptions imperfect and complicated, but: Clinicians often estimate that more than 99% of care decisions are made outside of the practice/office setting, where independent patient decision-making is essential (12) .

Compliance

• A prescription defined by a health-care provider must be followed. • “This is what you need to do” … and it is done … and it should work. • It is implied that if it doesn’t work, it’s the patient’s fault.

As the need for advanced self-management skills gained recognition, the “empowerment” approach has evolved, which is now the driving philosophy behind SME and SMS (10-12,42,43). The techniques of persuasion, traditional education and advice-giving, which have been shown to have limited effectiveness when it comes to chronic health issues, are no longer the tools of choice. Using an empowerment approach, a person is able to make informed decisions and