Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-61

This is the most challenging stage for most providers and chronic disease management planners: How to reach a person/population who does not want to be reached? • Contemplation : People may be aware of the need or potential for change, but have not yet made a commitment to action. At this stage, the patient still sees the barriers to change as outweighing the positive outcomes and lacks the confidence to move forward, but is beginning to think about making the change. It is important for the health professional to help the patient identify the importance of personal behaviour change and potential solutions. • Preparation : Patients are intending to take action in the near future and may take some steps toward trying out the new behaviour. They are very close to making a change and may have taken small positive steps already. The benefits of making a change at this stage are at least equal to the barriers. It is time for the health professional to help the patient explore specific strategies for taking action. • Action : The patient is engaging in the new behaviour (first six months). He/she can be helped to identify and use ongoing education, psychological and social support networks to ensure continued success and to prevent relapse. The health professional should provide feedback, assistance with coping skills and problem-solving skills, which help to deal with the ongoing barriers to change and the burden of living with a chronic illness. The patient will need preventative steps and/or interventions to deal with the human tendency for relapse. • Maintenance : The patient works to sustain the new behaviour and prevent relapse (longer than six months). Health professionals need to offer ongoing feedback/reminders, problem-solving support and encouragement for the patient’s efforts, supporting all positive changes. Success in one area may inspire the conviction and energy to move into action in another area. Change process A change process is a broad category of interventions and methods with multiple techniques and methods, grouped together in a “classification” (180). The stages of change are linked to an educational approach/intervention via these change processes, which have been derived from most of the models of human behaviour and learning theories previously described (179,181). The intent is to take the best from all approaches and learn when they are most appropriate; that is, find the right approach for the right person at the right time. Most approaches or teaching methods do have a place; they are neither all correct nor all incorrect.