Perspectives in Practice
Psychosocial Issues in Diabetes Self-Management: Strategies for Healthcare Providers

https://doi.org/10.1016/j.jcjd.2013.01.002Get rights and content

Abstract

Education and training for diabetes mellitus self-management is widely available and an essential part of many diabetes centres. Nonetheless, the majority of individuals with diabetes do not adhere to optimal self-management recommendations. It is believed that psychosocial issues play an important role in individuals' ability to undertake the extensive behavioural demands involved in managing diabetes. The goal of the present article is to provide an overview of psychosocial issues and suggest strategies for healthcare providers in supporting patients with the challenges of diabetes self-management. First, motivational enhancement strategies have the potential to augment patients' own motivation to engage in health behaviours. Second, behavior modification principles can increase patients' self-efficacy and their experiences of success. Third, managing distressing emotions, including anxiety, depression, distress specifically related to diabetes care, and fear of hypoglycemia, can facilitate motivation and ability to undertake diabetes self-management efforts. Recognizing and addressing psychosocial challenges allows healthcare providers to better support their patients in the demanding tasks of diabetes self- management.

Résumé

L'enseignement et la formation sur la prise en charge autonome du diabète sucré sont largement disponibles et font partie intégrante de plusieurs centres. Néanmoins, la majorité des individus ayant le diabète n'observe pas les recommandations pour une prise en charge autonome optimale. Il semble que les problèmes psychosociaux jouent un rôle important dans l'habileté des individus à assumer les nombreuses exigences comportementales imposées par la prise en charge du diabète. L'objectif du présent article est de donner un aperçu des problèmes psychosociaux et de suggérer des stratégies aux prestataires de soins de santé pour aider les patients à relever les défis de la prise en charge autonome du diabète. Premièrement, les stratégies de renforcement de la motivation ont le potentiel d'accroître la motivation personnelle des patients à adopter des comportements en matière de santé. Deuxièmement, les principes de modification du comportement peuvent accroître la connaissance de ses propres capacités et leurs expériences de succès. Troisièmement, la prise en charge de la détresse émotionnelle, incluant l'anxiété, la dépression, la détresse propre aux soins liés au diabète et la peur de l'hypoglycémie peut faciliter la motivation et l'habileté pour déployer les efforts nécessaires à la prise en charge autonome du diabète. Reconnaître et aborder les défis psychosociaux permet aux prestataires de soins de santé de mieux soutenir leurs patients vis-à-vis du travail exigeant qu'impose la prise en charge autonome du diabète.

Section snippets

Psychosocial Issues in Diabetes Self-Management: Strategies for Healthcare Providers

Managing diabetes mellitus is a grueling and unrelenting responsibility. Although a physiological disease, the management of diabetes is largely behavioural (1). Diabetes management demands constant health monitoring, decision-making, and strict behavioural standards on diet, exercise, self-monitoring of blood glucose and insulin administration. These are challenging tasks even for individuals with a strong interest in health, let alone for those who take them on after a diagnosis of diabetes.

Normalizing that Health Behaviour Is Abnormal Behaviour

One important role of HCPs who work with individuals with diabetes is acknowledging and normalizing the challenges of diabetes management. Many patients often feel overwhelmed by diabetes and struggle with feelings of failure and low self-confidence with respect to the health behaviour changes required to manage diabetes. By openly acknowledging that optimal self-care behaviour is actually not the norm and is in fact relatively rare 1, 6, 7, HCPs can help patients feel that they are not alone

Readiness Assessment

Before making specific plans and providing advice and recommendations for behaviour change, it is helpful to assess patients' readiness for change to determine which behaviour changes they are ready, willing and able to undertake (8). When patients answer any readiness for change question (see Appendix 1) with either a “no,” “not really,” or a “yes but,” HCPs should proceed by focusing on motivational enhancement (9).

Motivational Enhancement

It is not the role of the HCP to motivate the patient. Rather, motivational enhancement involves understanding and augmenting a patient's own reasons for change. There are a few concepts about the nature of motivation that can facilitate HCPs effectiveness in interacting with patients about behaviour change (8).

Behaviour Change Strategies

Once patients demonstrate an intention to change and begin engaging in change talk, HCPs can use principles of behaviour modification to support them in making changes that are sustainable over the long-term. One of the best predictors of behaviour change is self-efficacy, which is confidence in one's ability to perform a specific behaviour (11). There are a few key principles of behaviour modification that, when used in a patient-centred manner, help HCPs approach behaviour change in a manner

Emotion management

Diabetes and mental health are inextricably linked. Individuals with diabetes are more likely to experience depression and anxiety than individuals in the general population 15, 16, 17. Even for individuals who do not experience these disorders at a clinical level, emotional distress, and especially distress specifically associated with diabetes management, can directly affect the body physiologically (18) and impede one's ability to engage in health behaviours 19, 20, 21, 22. Conversely, a

Brief Psychosocial Interventions

For diabetes HCPs interested in incorporating more formalized psychosocial care in their practice, multisession psychosocial interventions have been shown to decrease A1C levels and emotional distress in diabetes patients 34, 35. Furthermore, briefer interventions with closely spaced sessions have been associated with more positive results, perhaps by allowing participants greater opportunity to remember and synthesize interventions' content (35). A 6-session weekly psychosocial group

References (36)

  • L. Fisher et al.

    A call for more effectively integrating behavioural and social science principles into comprehensive diabetes care [editorial]

    Diabetes Care

    (2007)
  • T.M. Vallis

    Psychological traps in diabetes self-care: to be forewarned is to be forearmed

    Can J Diabetes

    (2001)
  • Canadian Diabetes Association

    Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada

    Can J Diabetes

    (2008)
  • T.A. Deakin et al.

    Group based training for self-management strategies in people with type 2 diabetes mellitus

    Cochrane Database Syst Rev

    (2005)
  • M. Peyrot et al.

    Psychosocial problems and barriers to improved diabetes management: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study

    Diabetic Med

    (2005)
  • W.R. Miller et al.

    Motivational interviewing: preparing people for change

    (2002)
  • Vallis M. Lifestyle counselling: more than meets the eye. Poster presented at the Family Medicine Forum, Vancouver,...
  • B.J. Thoolen et al.

    Beyond good intentions: the role of proactive coping in achieving sustained behavioural change in the context of diabetes management

    Health Psychol

    (2009)
    • View full text
    Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.