By Nicola Davies, PhD
The 2017 National Standards for Diabetes Self-Management Education and Support remind us of the importance of lifelong diabetes instruction. The guidelines, created by the Standards Revision Task Force, state the essential role of your diabetes self-management education and support (DSMES or DSME) team. Among the members of this team are professional diabetes educators from the health-care industry, trained paraprofessionals such as community health workers, psychologists, and peer instructors. Together, these individuals create a multidisciplinary partnership that can deliver the psychoeducation needed to empower you to better manage your diabetes.
Psychoeducation is the delivery of systematic, relevant, and broad information on your medical condition. The information can be accessed through your community clinic, your primary-care doctor, or websites of professional diabetes education groups. Such programs are comprehensive and provide support at all stages of your diabetes journey, starting from diagnosis and continuing through to treatment and self-management.
A good psychoeducation program provides you with more than disease-specific information; it helps you with lifestyle-related information such as cooking tips to help you change your diet. The program may also offer you the opportunity to involve your friends and family. Your support network can only benefit from knowing more about your condition, and psychoeducation programs can help educate them on the most effective ways to help you. Alternatively, the program may offer you guidance on how to communicate with and educate your support network yourself.
According to Beverly Adler, PhD, a clinical psychologist and certified diabetes educator who received the Certified Diabetes Educator Entrepreneur of the Year award in 2016, psychoeducation can help people with diabetes in many ways. “Psychoeducation can improve diabetes self-management and reinforce motivation to adopt an active role in diabetes treatment. Psychoeducation can address difficulties that people with diabetes may have regarding their affect (feelings), cognitions (thoughts), behaviors (actions), and relationships with others.”
Some of the topics psychoeducation can address include:
• healthy eating (carbohydrate counting, alcohol consumption);
• lifestyle interventions (exercise regimens, tips for traveling); and
• mental health issues (how to deal with denial, anger, anxiety, depression/diabetes distress, and acceptance).
Adler says her focus is to help people with diabetes learn management skills, problem-solving, cognitive restructuring, and stress management. “My aim is for patients to feel empowered to manage their self-care. I also teach them about self-compassion, which has been shown in the literature to positively correlate with higher well-being, lower A1C, and higher engagement with all self-management behaviors, including dietary care and physical activity,” she says.
You can choose to attend individual psychoeducation, group psychoeducation, or a mix of both. A combination of individual and group education may be the most effective approach, resulting in the most significant decreases in hemoglobin A1C (HbA1c, or simply A1C) levels. “Groups, in general, provide educational, social, and emotional support,” says Adler. Other benefits include normalization, encouragement, and fellowship.
• Normalization: Hearing that other people with diabetes have similar issues can be comforting, as can the realization that you are not alone in facing certain challenges. Many people experience relief when they meet others who are in the same situation.
• Encouragement: People with diabetes can share tips and tricks for better management. Group members can also pass on to one another their own solutions to common problems.
• Fellowship: People with diabetes share a common bond around a common health issue. Other members of the group may serve as role models as they discuss how they successfully manage their self-care.
In group psychoeducation, you will find people with the same medical condition but varying personalities, life experiences, and socioeconomic backgrounds. The diversity of the group can be beneficial; while you may find fellow members to be very different from each other, everyone in the group is addressing the same health issues, from diet and weight concerns to fears of hypoglycemia. Simply having the opportunity to share experiences can be enormously helpful.
Research analyzing 47 studies on the effectiveness of group-based self-management education among persons with Type 2 diabetes shows that this type of intervention leads to better health outcomes. Specifically, group-based education has led to lower HbA1c levels and improved outcomes for triglyceride levels, fasting blood glucose, waist circumference, body weight, and diabetes knowledge. In addition, education via group interactions rather than written information encourages connections that can address an important psychological need called relatedness, feeling respected, understood, and cared for by others. This, in turn, can enhance group members’ motivation to self-manage.
The most essential consideration to keep in mind when looking for your own psychoeducation group is to ensure that the group is facilitated by an experienced clinician who is skilled in presenting knowledge in a way that you easily understand. The facilitator must be good at maintaining group interactivity, creating an atmosphere in which it is easy and safe for you to share your thoughts. In addition, the facilitator must be able to:
• understand you as a whole person so that he or she can help develop your strengths and resilience;
• provide emotional support and guidance as well as relevant information about your condition;
• promote healthy daily habits such as regular exercise, good sleep hygiene, proper nutrition, and ways to elicit support from your friends and family; and
• make sure that you, your family members and other caregivers can access trusted online resources or printed handouts. You may want to revisit the content you heard at the psychoeducation session or do more in-depth research yourself.
One of the most important advantages of group-based psychoeducation is that it is often tailored to meet different needs of people with diabetes. Look for diabetes self-management education (DSME) groups that you have a lot in common with, such as those located in or near your own community or those with the same type of diabetes as yours. You might even want to consider family-based psychoeducation.
• Community-based programs have been shown to encourage better glycemic control and healthy habits. Many programs now recognize the value of meeting populations at the venues closest to where they live.
• Family-based DSME interventions can promote improved A1C management by encouraging (and sustaining) lifestyle modifications and self-care. Sharing your education experience with a trusted family member or caregiver could be very beneficial. It provides your loved ones with the opportunity to join you in behavioral and lifestyle changes that can improve the health of the entire family.
• Groups based on background and demographics may be the best choice for some people because the members are close to your age and have similar life experiences. For example, the American Diabetes Association runs several Awareness Programs aimed at supporting people with diabetes. These programs include Family Link, which helps connect families of children with diabetes.
These are just a few examples of psychoeducation groups. With some help from your health-care provider and your own research, you will be able to find the group that best fits your needs.
There are some misconceptions about psychoeducation groups. One of these is that, compared to therapy or counseling groups, psychoeducation groups are not “real” interventions. This is simply not the case. Psychoeducation groups are real interventions with a clear purpose and defined goals. To ensure that these goals are met, members need to be committed and willing to fully participate. They must be open about their ideas, experiences, and thoughts on living with diabetes.
Adler observes that, “Some people might feel uncomfortable attending group psychoeducation, believing that is not as effective as individual psychoeducational interventions.” However, group-based psychoeducation works just as well as individual psychoeducation, she adds. “Research has demonstrated the effectiveness of group psychoeducation, with people who have diabetes and mild to moderate depressive symptoms achieving improvements in depression, as well as comparable improvements in A1C values after six- and 12-month follow-up periods.”
Psychoeducation is an important part of lifelong diabetes management. Using these groups to develop a deeper understanding of your condition can bring about a transformation in the way you deal with your condition day to day and can also help your support network better understand the challenges you face. If you feel you could benefit from this kind of psychological intervention, speak to your primary-care physician, local diabetes clinic, or health-care provider about how to incorporate these sessions into your treatment plan. By working together, you will be able to find the program that will most effectively enhance your self-management journey.
Want to learn more about your diabetes care team? Read “Members of Your Diabetes Care Team,” “Diabetes Management: It Takes a Team,” and “Your Diabetes Care Team.”
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