Are Behavioural Interventions Doomed to Fail? Challenges to Self-Management Support in Chronic Diseases

Vallis, Michael

doi:10.1016/j.jcjd.2015.01.002

Cited by 35 publications

(29 citation statements)

References 40 publications

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“…49 In group-based education, person-centeredness can be particularly difficult to integrate into the educational setting due to patients' varying needs, values, and preferences. 54,55 The present study also found helplessness in both patients and HCPs. Patients expressed helplessness in relation to controlling diet and blood sugar levels.…”

Section: Discussionsupporting

confidence: 74%

<p>A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area</p>

Christensen¹,

Drejer²,

Burns³

et al. 2020

PPA

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Background: Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM. Aim: To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs). Methods: Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation. Results: The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one's social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs. Conclusion: Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.

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Section: Discussionsupporting

confidence: 74%

<p>A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area</p>

Christensen¹,

Drejer²,

Burns³

et al. 2020

PPA

View full text Add to dashboard Cite

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“…The reality that health-related behavior change is actually more about the patient than clinicians may be difficult for some to accept. 24 Many health systems value the top-down organizational approach to service delivery that places the patient on the receiving end of the service/health system benefit. However, in the BCHAT experience, the co-piloting approach leads to a prophylaxis plan that is designed by and makes sense to the patient, and to which the patient is more likely to adhere.…”

Section: Discussionmentioning

confidence: 99%

Joining the patient on the path to customized prophylaxis: one hemophilia team explores the tools of engagement

Gue

Squire

McIntosh

et al. 2015

JMDH

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BackgroundThe relationship between hemophilia team interventions and achievement of optimal clinical outcomes remains to be elucidated. The British Columbia Hemophilia Adult Team has previously reported results of a comprehensive approach to individualize prophylaxis that has resulted in substantially reduced bleeding rates. In order to facilitate knowledge exchange and potential replication, it was important to gain a thorough understanding of the team’s approach.MethodsA focus group of the British Columbia Hemophilia Adult Team was conducted to identify specific roles and processes that might be contributing to the prophylaxis regimen outcomes in this clinic. The focus group consisted of two workshops; one to describe the individual and collective roles of the clinic team in providing clinical care and guiding patients toward individualized prophylaxis; and the other to describe the patient journey from initial contact through reaching a successful engagement with the clinic.ResultsAnalysis of the results revealed team roles and processes that underpinned a shared decision-making relationship with the patient with a particular focus on supporting the patient’s autonomy. Within this relationship, team focus shifts away from “adherence” toward the process whereby patients design and implement prophylaxis regimens resulting in reduction or elimination of bleeding episodes.LimitationsUsing the current methodology, it is not possible to demonstrate a causal link between specific team processes and improved bleeding rates in patients.ConclusionThrough the active support of patient autonomy in all aspects of decisions related to hemophilia management, the British Columbia Hemophilia Adult Team approach de-emphasizes “adherence” as the primary goal, and focuses on a prophylaxis plan that is customized by the patient and aligned with his priorities. Adoption of this comprehensive team approach facilitates shared goals between the patient and the team that may optimize treatment adherence, but more importantly, reduce bleeding rates.

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“…An expert-dominated approach to assessment can foster tension and create conflict; HCPs may interpret it as judgmental and confrontational and respond in guarded, defensive, and superficial ways, limiting their acquisition of new skills and behaviors [21–24]. Assessments in which experts dominate and provide recommendations and advice on specific actions are morally directed and can impair, rather than improve, person-centered professional skills [25, 26]. …”

Section: Introductionmentioning

confidence: 99%

The potential of a self-assessment tool to identify healthcare professionals’ strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education

et al. 2017

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BackgroundHealthcare professionals’ person-centered communication skills are pivotal for successful group-based diabetes education. However, healthcare professionals are often insufficiently equipped to facilitate person-centeredness and many have never received post-graduate training. Currently, assessing professionals’ skills in conducting group-based, person-centered diabetes education primarily focus on experts measuring and coding skills on various scales. However, learner-centered approaches such as adequate self-reflective tools have been shown to emphasize professional autonomy and promote engagement. The aim of this study was to explore the potential of a self-assessment tool to identify healthcare professionals’ strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education.MethodsThe study entails of two components: 1) Field observations of five different educational settings including 49 persons with diabetes and 13 healthcare professionals, followed by interviews with 5 healthcare professionals and 28 persons with type 2 diabetes. 2) One professional development workshop involving 14 healthcare professionals. Healthcare professionals were asked to assess their person-centered communication skills using a self-assessment tool based on challenges and skills related to four educator roles: Embracer, Facilitator, Translator, and Initiator. Data were analyzed by hermeneutic analysis. Theories derived from theoretical model ‘The Health Education Juggler’ and techniques from ‘Motivational Interviewing in Groups’ were used as a framework to analyze data. Subsequently, the analysis from the field notes and interview transcript were compared with healthcare professionals’ self-assessments of strengths and areas in need to effectively facilitate group-based, person-centered diabetes education.ResultsHealthcare professionals self-assessed the Translator and the Embracer to be the two most skilled roles whereas the Facilitator and the Initiator were identified to be the most challenged roles. Self-assessments corresponded to observations of professional skills in educational programs and were confirmed in the interviews.ConclusionHealthcare professionals self-assessed the same professional skills as observed in practice. Thus, a tool to self-assess professional skills in facilitating group-based diabetes education seems to be useful as a starting point to promote self-reflections and identification of healthcare professionals’ strengths and areas of need of professional development.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1003-3) contains supplementary material, which is available to authorized users.

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Are Behavioural Interventions Doomed to Fail? Challenges to Self-Management Support in Chronic Diseases

Cited by 35 publications

References 40 publications

<p>A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area</p>

<p>A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area</p>

Joining the patient on the path to customized prophylaxis: one hemophilia team explores the tools of engagement

The potential of a self-assessment tool to identify healthcare professionals’ strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education

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