Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-63

Counter-conditioning

Coping-skills training

Substituting alternatives for the undesirable behaviour

Reinforcement management

Feedback reports

Rewarding for making positive changes

Most educational experiences involve a combination of processes. For instance, the empowerment protocol uses a combination of consciousness raising, dramatic relief, helping relationships and self-evaluation.

Integrating theory and practice You may find it challenging to understand and select a theory that best fits your practice and your philosophy. However, as current SME and SMS literature states, SME and SMS programs should be designed with a theoretical basis guiding the assessment, planning, implementation and evaluation components, whether they be individual- or population-based (166,183-185). In the face of the numerous models and theories attempting to inform us about education and behaviour change, we continue to look for a theory that gives unity to the SME and SMS process.

The TTM may provide direction for the development of SME, SMS and health-promotion activities, including healthy heart education, asthma and diabetes programs. Or the social cognitive theory of self-efficacy may do so. Consensus on one accepted comprehensive theory of human behaviour has not been reached despite decades of debate (46,166,183-185). Peyrot and Rubin agree that all these theories can

Key Principle: The major question remaining for educators today is not if SME and SMS affects knowledge or self-management, but rather when, how, how much, by whom and what critical core of knowledge/behaviour is needed to make a difference (183).

appear to be “a bewildering jumble” (46). They propose that apparent, but perhaps irrelevant, differences in proposed models of behaviour can be resolved by establishing four categories of factors that should be the target of behaviour change (46).