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“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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mapping out group diabetes education blending persons with mono multilingual backgrounds
“Mapping” Out

Group Diabetes Education:

Blending Persons

with

Mono/Multilingual Backgrounds

Laura Shane-McWhorter, PharmDBCPS, BC-ADM, CDE, FASCP, FAADE

objectives
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
what is group education
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

a comparison of two models
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

why group education
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?
knowles theory adult learning
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
using health information
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”
healthcare outcomes continuum
Healthcare Outcomes Continuum

Learning

Behavior Change

Clinical Improvement

Improved

Health Status

Diabetes Educator 2001;27:547-62

group vs individual in t2dm
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

a1c group vs individual
A1C: Group vs Individual

GE IE

9.0 6.5 8.2 6.5

Diabetes Care 2002;25:269-274

group vs individual cochrane review
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

a1c group vs individual vs usual using conversation maps
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

educator skills
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

preparing for group education
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
cultural competency
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
defining culture
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
how does this affect us
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
why is the country of origin important
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?
culture and hispanic patients
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
important terms
Important Terms
  • Cultural Values
    • Familismo
    • Personalismo
    • Simpatía
    • Respeto
    • Fatalismo
  • Language
preparing for group education1
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

preparing for group education2
Preparing for Group Education
  • STARTT
    • Set Up
    • Tell
    • Assess
    • Reflect
    • Track
    • Transition

Diabetes Spectrum 2010;23:194-198

preparing for group education3
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

preparing for group education4
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

preparing for group education5
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

preparing for group education6
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

preparing for group education7
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

preparing for group education8
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

group education evaluation
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
using conversation maps
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
using conversation maps1
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
using conversation maps2
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