Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-35

Benefits of SME combined with SMS: Research has shown that combining SME and SMS has led to (1,7,25,53,74,76,108): Improvement in: Reduction in: Glycemic control Diabetes distress Self-efficacy Foot complications Self-care behaviours As diabetes educators, we strive to support the individual in maintaining positive self-care behaviours. For the purposes of this manual, we are primarily interested in which models of support have proven helpful in promoting long-term diabetes self-management at the individual level. Health-care professionals joined by peer supporters Questions frequently asked regarding self-management are: “Who is the best person to deliver support? Is peer support more effective than support given by the HCP?” Research shows mixed results. In the recent PRISM report, the authors conclude the role of the educator is critical, but other agents can be used if trained appropriately (110). Klein’s results suggested that the addition of a nurse, along with other educators, might increase the effectiveness of the intervention (61). Combined results from a review of volunteer-based peer-support interventions in diabetes suggest that “the most favourable findings are for psychosocial outcomes with peer-support interventions, leading to greater self-efficacy, higher diabetes-specific quality of life and fewer depressive symptoms when compared to usual-care control groups” (111). Cost effectiveness has been frequently quoted as a driving force behind peer-led programs, but others contend that there is a large initial investment both in time and money needed for training. Tang and others suggest that, although the peer-support model offers “greater flexibility and customization compared to the professional-led model”, there are several inherent problems with peer-led programs (112,113). These include the lack of standardized training, the lack of follow-up training and the difficulty of retention. Despite these concerns, the success of many community health worker support programs and peer-led groups has proven that they are valuable additions to SME interventions (114).