Building Competency in Diabetes Education THE ESSENTIALS

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cutting our lawns, and putting out the garbage. We often follow the examples of our colleagues and learn how to do our jobs by ‘modeling’ the behaviour we have observed others do. If we do not get a positive response, we are not likely to repeat the behaviour. If we do not have the confidence or expected reward to engage in some behaviour, i.e. change in eating habits, the action is not likely to occur. The social cognitive theory has been used extensively in health education to promote healthy behaviours. A classic example of this is how environmental influences have been used to curtail smoking. By limiting the areas available for smoking, using role models in the media to spread the message of this being a negative behaviour, and setting up the anticipated negative response if one engages in this behaviour, smoking has been effectively decreased. Public health initiatives for healthier eating, increasing exercise, avoiding sugar-sweetened drinks and safe driving have all used the premise of reciprocal determinism to influence behaviour change (157,160,161). Health Belief Model This model seeks to describe how patients choose to engage (or not) in preventative behaviours and adhere to prescribed regimens. Variables include the following (162,163): • Perceived Susceptibility : This refers to the individual’s subjective belief of the probability of acquiring the disease. If one feels that they may actually get the disease, they are much more likely to engage in behaviour to avoid it. • Perceived Severity : This refers to the individual’s belief that, if diagnosed, the disease can be serious and it can have serious consequences. The more serious the individual views the disease, the more likely they are to take action to avoid it. If diagnosed with the disease and they feel it can have serious consequences, the more likely the individual is to deal with it. • Perceived Benefits : This refers to the individual’s belief that, if the advised action is taken, there will be a positive outcome, such as risk reduction or less of an impact of the disease. Action results in benefit or benefits to the individual. The individual is more likely to engage in action if the benefits are clearly identified and if they hold significance for the person. • Perceived Barriers: This refers to the individual’s belief relating to the cost of taking action. The cost may be seen in terms of the psychological effort needed to take action, financial expenses, or it could be expressed in many other realms of concern. The greater the perceived barrier is to take action, the less likely the individual is to proceed.