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Laura Shane-McWhorter, PharmD BCPS, BC-ADM, CDE, FASCP, FAADE

“Mapping” Out Group Diabetes Education: Blending Persons with Mono/Multilingual Backgrounds. Laura Shane-McWhorter, PharmD BCPS, BC-ADM, CDE, FASCP, FAADE. Objectives. To become familiar with benefits and challenges of group sessions that combine patients with different backgrounds

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Laura Shane-McWhorter, PharmD BCPS, BC-ADM, CDE, FASCP, FAADE

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  1. “Mapping” Out Group Diabetes Education: Blending Persons with Mono/Multilingual Backgrounds Laura Shane-McWhorter, PharmDBCPS, BC-ADM, CDE, FASCP, FAADE

  2. Objectives • To become familiar with benefits and challenges of group sessions that combine patients with different backgrounds • Examples of how to use “conversation maps” to conduct group sessions with patients of different backgrounds

  3. What is “Group Education?” • A system of combining learning experiences • Active, goal-directed process • Transforming knowledge skills and values into new behavior • Achieving an “intentional” goal Mensing C: Diabetes Spectrum 2003;16:96-103

  4. A Comparison of Two Models Medical-Centered Model Patient-Centered Model • “Compliance” • Provider is in charge • Planning for patient • “Passive” patient • Fosters “dependence” • Provider determines needs • Autonomy • Patient is in charge • Patient plans with provider • “Active” patient • Fosters “independence” • Patient defines needs • EMPOWERMENT Patient Educ Couns 2001;44:23-27

  5. Why Group Education? • Uses the patient-centered model rather than medical-centered model • Places patient “in the driver’s seat” • Allows for patient autonomy • Allows for active participation • Patient defines their needs with the medical team • Patient does not feel “alone” with diabetes • Overall, patient empowerment • Can provide care for more individuals • Cost?

  6. Knowles Theory: Adult Learning • Adults need to know reason for learning • Experience (including error) is basis for learning • Involvement in planning/evaluation of their instruction • Must be relevant to work/personal lives • Problem-centered not content centered • Respond better to internal rather than external motivation

  7. Using Health Information • Knowledge • Difficult to translate knowledge into action • May be educated, but not engaged • Relating health information to individual experiences • Learn from hearing others’ experiences • Feel support from hearing they are not alone • Helps persons make a “personal action plan”

  8. Healthcare Outcomes Continuum Learning Behavior Change Clinical Improvement Improved Health Status Diabetes Educator 2001;27:547-62

  9. Does Group Education Work?

  10. Group vs Individual in T2DM • N=87 randomized to group education (GE); N=83 randomized to individual education (IE) • Pts received 4 sequential sessions delivered at consistent times over 6-mo • Initial session 3 h for GE; 2 h for IE • 2-wk F/U was 2 h for GE; 1 h for IE • 3-mo F/U was 1 h for GE; 1 h for IE Diabetes Care 2002;25:269-274

  11. A1C: Group vs Individual GE IE 9.0 6.5 8.2 6.5 Diabetes Care 2002;25:269-274

  12. Group vs IndividualCochrane Review Significantly greater A1C decrease 1.4% at 4-6 mo (p<0.00001) 0.8% at 12 mo (p<0.00001) 1.0% at 2 yrs (p<0.00001) N=1532 persons in 11 RCTs Significantly greater FBG decrease at 12 mo 22 mg/dL (p<0.00001) Significantly improved Diabetes Knowledge at 12-14 mo (p<0.00001) Deakin TA, McShane CE, Cade JE, Williams R Cochrane Database Systemic Reviews 2009; Issue 2. Art No.:CD003417

  13. A1C: Group vs Individual vs Usual(Using Conversation Maps) P=0.008 GE (-0.27) IE (-0.51) UC (-0.24) 8.07% 7.8% 8.14% 7.63% 8% 7.76% Arch Intern Med 10/14/2011; Doi:10.1001/archinternmed.2011.507

  14. Educator Skills • Preparation • Develop delivery options created to enhance subject content • Role play, role modeling • Demonstration, discussion, games • Assess learners • Use motivational interviewing • Documentation (forms) • Plan for behavior changes/lifestyle • What learners expect to accomplish Mensing C: Diabetes Spectrum 2003;16:96-103

  15. Preparing for Group Education • Know the audience • Consider inviting multidisciplinary members that may help with meeting cultural needs of the group • Are interpreters needed? • Research ethnic foods • Be prepared to facilitate how group members may interact • Try this out with a small number of individuals first • Consider cultural issues that may affect diabetes care

  16. Cultural Competency • Definition? • Ability to recognize differences, identify similar patterns of responses, avoid stereotyping by acknowledging variations, providing caring actions . • Becoming culturally competent • Knowledge, awareness, sensitivity

  17. Defining Culture • Patterns of human behavior that bind a racial, ethnic, religious, or social group within a society • The human behavior patterns include: • Values • Beliefs • Customs • Actions • These behaviors are learned early in infancy and passed from generation to generation

  18. How Does This Affect Us? • Educators must be willing to learn about, understand, and respect cultural differences • Educators must seek to incorporate important cultural norms into the care giving process

  19. Why Is The Country of Origin Important? • In Hispanics, the same word may have different meanings • Example: “almuerzo” • Example: “dinner” • Customs may differ: • Types of foods • When meals are eaten • Issues with “beverages” • Attitudes toward treatments may differ • Teaching tools may need adaptation • Pictograms – thermometer in the mouth or axilla?

  20. Culture and Hispanic Patients • First, an understanding of Hispanic culture is extremely important • e.g., cultural competence • What is culture? • Behavior patterns, beliefs, arts, and other products of human thought and work that are expressed in a particular community

  21. UnderstandingImportant Terms

  22. Important Terms • Cultural Values • Familismo • Personalismo • Simpatía • Respeto • Fatalismo • Language

  23. Preparing for Group Education • Schedule an individual session first to get to know the patient • Helps to know who may work well with others • Let the “invitees” know what is being planned • Target patients “out of range” • “Invite” participants • Plan for anywhere from 3-8 participants • Not more than 10 Diabetes Spectrum 2010;23:194-198

  24. Preparing for Group Education • STARTT • Set Up • Tell • Assess • Reflect • Track • Transition Diabetes Spectrum 2010;23:194-198

  25. Preparing for Group Education • Set Up • Review participants’ medical history • Gather supplies • Set up the meeting area • Determine optimal placement of tools Diabetes Spectrum 2010;23:194-198

  26. Preparing for Group Education • Tell • Set ground rules • Respect limits on participant speaking time • Describe the tools • Schedule breaks • Location of restrooms Diabetes Spectrum 2010;23:194-198

  27. Preparing for Group Education • Assess • “Introductions” to determine dynamics • Helps instructor know where patients are with respect to DM management • Provides insight into how to manage group’s personalities • Helps to establish what languages are reflected • Helps to establish what cultures are reflected Diabetes Spectrum 2010;23:194-198

  28. Preparing for Group Education • Reflect • Must be able to throw questions back to group • Correct any mis-information • “Fill in the blanks” prn • Helps to establish what cultures are reflected Diabetes Spectrum 2010;23:194-198

  29. Preparing for Group Education • Track • Checklist of discussion topics • Materials packet • Handouts, others • Verify that all topics are addressed Diabetes Spectrum 2010;23:194-198

  30. Preparing for Group Education • Transition • Made by going from didactic to facilitation approach • Take advantage of available training venues • Other tools for educators Diabetes Spectrum 2010;23:194-198

  31. Group Education - Evaluation • What worked/what didn’t? • Did we keep it simple? • Did we continue to problem solve? • Did it remain “patient centered?” • Were active-learning principles used? • Educators must renew teaching skills and use multiple strategies and resources that continue to evolve

  32. Conversation Maps

  33. Using Conversation Maps • 4 maps • Map 1 – DM overview • Map 2 – Relationship between DM and food • Map 3 – Monitoring BG • Map 4 – Natural course of DM • Map 5 – GDM

  34. Using Conversation Maps • 6 components of using maps • Use a map visual • Ask conversation questions • Use discussion cards • Enable group interaction • Facilitation • Action plan • Each map ~ 2 hours

  35. Using Conversation Maps • An example - Map 1 • Provides an overview of DM • Designed to “dispell” common myths • Discuss feelings associated with having DM • Use conversation questions • Use discussion cards • Launch group interaction, facilitation • Develop an action plan • Intent – empower individuals to take responsibility for their own health and well-being

  36. Let’s Try It Out

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