Building Competency in Diabetes Education THE ESSENTIALS

11-8 | CHAPTER 11

they were trying to juggle’, for example healthy eating, weight loss and stress. Through this ‘cognitive monitoring’ patients identified their problem areas, realized possible causes and planned for potential solutions. As Klein suggests:

SME “rooted in a cognitive model of system dynamics could supplement the teaching of rules and procedures to help patients with type 2 diabetes become more adaptive and successful” (7).

Earlier studies focused more on behavioural therapies (such as goal-setting, reinforcement management, behavioural contracting and rewards), while more recent studies incorporate cognitive therapies (such as supportive counselling, motivational interviewing, and social-skills training) (12). The results to date seem to indicate that there may be some strategies used more effectively depending on the domain of self-management we are working with. Strategies used to teach knowledge and skills may be different than the strategies needed to sustain self-care behaviours (9). Clearly educational and psychological theories overlap, with social-cognitive (or self-efficacy) theory and the Transtheoretical (or Stages of Change) Model remaining predominant in the literature. The results of the DAWN2 study augment the original DAWN study, supporting the inclusion/integration of psychosocial aspects within the practice of diabetes SME (13,14). The original Diabetes Attitudes, Wishes and Needs (DAWN) program, a global initiative of the International Diabetes Federation and Novo Nordisk A/S, validated the impact of psychosocial factors on diabetes self-management worldwide (13). This large international study involved telephone or in-person interviews with more than 5,000 patients and almost 4,000 health-care professionals in 13 countries.

The study revealed that people with diabetes have major psychosocial issues and distress associated with poor self-management efforts, but that these factors are not effectively addressed in existing health-care systems (13) .

In the DAWN2 study, released in 2013, there were 8,596 adult participants with diabetes (type 1 and type 2), 4,785 health-care professionals caring for people with diabetes and 2,057 family members of people with diabetes surveyed across 17 countries. The purpose of this study was to revisit the question of “What is the psychosocial impact of diabetes?” and “How are we