Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-57

• Self-Efficacy: As stated previously, this refers to the confidence a person has in performing a behaviour. • Cues to Action: Prompts calling for change. The Health Belief Model was originally developed in the 1950s in response to a study regarding health screening for tuberculosis (164). Despite the scare of tuberculosis, the public was not taking advantage of free screening services. The theory explains that if a person does not believe they are susceptible to acquiring a disease, they will not take any measures to prevent it (165). A later addition to the Health Belief Model was the concept of self-efficacy, where it was recognized that people need to believe they can actually accomplish a task in order to engage in it (164). Applying this theory to diabetes prevention, it is understandable why we have not been successful at engaging people in healthier behaviours. If a person does not believe they will develop diabetes, they have no reason to change their behaviour. The patient’s personal value system, often based on religious or spiritual beliefs, is potentially the main barrier or facilitator for behaviour change (155). It is imperative in our education campaigns that we not only stress the risk factors for the development of diabetes and the severity of the potential complications, but also that we acknowledge and work with the patient’s attitudes, beliefs and their goals which form their personal value system (155,150). Our negative messages need to be balanced by the positive message that the benefits of healthier behaviours outweigh the barriers and action can result in prevention. Our efforts also need to encourage self confidence in order to initiate any change (163). Cognitive-Behavioural Interventions The term cognitive-behavioural is often used to describe a large number of programs and strategies today. It is not really a theory of behaviour change; it is more a description of a type of intervention. Ismail refers to this term as describing “an umbrella of interventions that develops a therapeutic alliance to change emotional, cognitive and behavioral function” (166). These interventions belong to both education and psychology. The term comes from the marriage of the “cognitive” school of thought and the “behaviourists”. Psychologists and educators recognized that knowledge alone does not bring about behaviour change, and that behaviour is not usually changed without first dealing with underlying thoughts and feelings. Both are part of effective educational experiences. We need to differentiate cognitive-behavioural interventions from cognitive-behavioural therapy (CBT). The