Building Competency in Diabetes Education THE ESSENTIALS

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Theories related to decisions about health behaviour A person’s ability and willingness to self-manage diabetes depends on many factors, including his or her personal values and health beliefs, knowledge, access to information, skills, motivation and financial constraints, as well as whether he or she perceives daily care regimens to be burdensome (155). Patients live as members of families and social/cultural groups, and they experience their illness from these perspectives (156). They have learned illness-management strategies and health beliefs since childhood and use this knowledge to manage disease and find relief or cure. These beliefs are open systems used to incorporate, modify or cast aside practices and convictions related to illness management. Health providers must work within the patient’s belief system and attempt to help him or her make informed decisions about the value and/or effectiveness of the treatments advised (155). A major challenge in diabetes management is that patients often do not see visible signs of illness that might inspire them to take action. It is important to collaborate and negotiate with patients while respecting their rights and belief systems (44). Several models of education or behaviour change have been proposed as foundations for SME and SMS programs (152,153). They tend to be derived from one of three main schools of thought: • Cognitive : Learning occurs by an internal thinking process. • Behaviourist : Learning occurs when behaviour is externally influenced. • Social cognitive : Learning involves cognitive, behavioural and environmental/social elements. Theories seek to explain why people learn or behave the way they do and then offer a method or strategy that will facilitate learning or change. The evidence from recent research suggests that theory-driven psychological interventions have been effective in behaviour change and are associated with good outcomes (95,96,155). Education for behaviour change is a challenging, complex and poorly understood endeavour that is both an art and a science. No one theory will solely account for change, but a combination of elements from the different theories can prove to be valuable. Also, you will note that many of the theories have common concepts. Following are brief descriptions of a number of major theories, selected to illustrate the complex decisions involved in learning about or engaging in health behaviours.