Building Competency in Diabetes Education THE ESSENTIALS

2-66 | CHAPTER 2

Applying behaviour change theories to education interventions When planning educational interventions, consider these important points:

• Any forward movement should be viewed as success. For example, the sedentary person who moves to thinking about starting a regular exercise program should be encouraged (181,182). • Patients should be aware that change occurs in stages, and that it is common to slip back. If they understand this, there is less chance of discouragement and an increased chance of moving forward after a relapse (181,182). • Educators need to use educational approaches that will facilitate an individual’s or group’s readiness to change. • Educational interventions will, by necessity, involve knowledge and/or skill and motivational elements. Interventions that include face-to-face delivery, cognitive-reframing teaching method and practical application content are more likely to improve glycemic control (184). • Didactic programs alone will not be effective for long-term behaviour change (185). Cognitive-behavioural strategies, such as motivational interviewing, need to be integrated into all educational programs. • An approach for implementing the empowerment philosophy in practice (known as the “empowerment protocol”) consists of five steps, similar to traditional problem-solving, but with a distinctive patient/family-centered twist (44,50):

1. Explore the problem or issue. 2. Clarify feelings and meaning. 3. Collaborate on a change plan. 4. Commit to action. 5. Experience and evaluate the plan. • The five C steps as proposed by Peyrot and Rubin are strikingly similar (46):

1. Construct a problem definition. 2. Use collaborative goal-setting. 3. Use collaborative problem-solving. 4. Contract for change. 5. Ensure continued support.