Building Competency in Diabetes Education THE ESSENTIALS

2-30 | CHAPTER 2

Whichever approach is used, an essential element to all the teaching interventions must be the recognition of the context into which the patient needs to apply his/her learning (1). Context implies that we consider: individual needs, culture, literacy levels, financial issues, family situation and any other factors involved in the determinants of health (10,81).

Self-care actions need to be understood in terms of the meanings attached to them, the context in which they take place, the norms they are subject to, the power over decision-making available to individuals and the social and emotional aspects of living with a chronic illness (17).

SME has been delivered in a variety of settings with the most frequently being individual, group, and through the use of multimedia technology (68). Which setting is most effective in facilitating successful self-management behaviour?

Individual versus group The controversy as to whether group sessions are superior to individual sessions has been debated at length. The majority of the research in this area has been done with patients with type 2 diabetes. The evidence supports both delivery methods with suggestions that the topic needs to be matched to the method and to the preferred learning style of the individual (76,82). SME delivered in the group setting has been seen as more effective for weight loss and quality of life improvements when compared to individual encounters (77,83). A recent meta-analysis showed that greater reduction in A1C (0.3%) occurred in group-based education programs compared to the control groups. They also found lower fasting blood glucose (BG) levels, body weight, triglyceride levels and an increase in diabetes knowledge in the group programs. However, these results changed over the time period the patients were followed (74). The cost effectiveness of group education has also made this a popular method for SME delivery (84). High rates of patient satisfaction have been reported following group sessions, such as in the DESMOND program, which offers group education to people with type 2 diabetes (83). Patients frequently state that they value group interventions because they have the opportunity to talk with their peers and have their questions discussed in a non-judgemental environment (83-87). Odgers-Jewell et al concluded from their meta-analysis that psychosocial and lifestyle outcomes showed greater improvement through group education interventions (74). Many innovative tools have been introduced to facilitate learning in groups, including the Diabetes Canada endorsed “ Conversation Maps ” (85,88). This tool exemplifies the