Utilizing Social Marketing and Motivational Interviewing to improve Diabetes MED INF 401 Bonnie Livingston Kristina Rogers Week 9 – May 28, 2008

What is Diabetes Mellitus? Disease in which insulin is either not produced or ignored by the body It is a chronic disease There are two types: ◦Type I ◦Type II

Type I Diabetes Most Commonly seen in children or young adults Also known as juvenile onset or insulin-dependent diabetes It is an autoimmune disorder in which the body is unable to produce insulin Approximately 5-10% of diabetics have type I diabetes

Type II Diabetes Also known as Adult onset or non- insulin dependent diabetes It is the result of insulin resistance An estimated 85-90% of type II diabetics are overweight or obese Increased # of fat cells contributes to ineffectiveness of insulin, and glucose remains in circulation Now becoming more prominent in children as childhood obesity rises

Potential complications of diabetes include: Heart disease Peripheral neuropathy/amputations Kidney failure, dialysis Retinopathy which can lead to vision loss

More on Diabetes In 2007, an estimated $174 billon was spent on diabetes ◦The annual cost per person was approximately $11,744 Prevalence rates are on the rise: ◦1980: 2.5% ◦2002: 4.2% ◦2007: 5.8% ◦2050: estimated to be 12%

An alarming trend: pre-diabetes 54 million people Will most likely turn into DM if ignored Blood glucose is elevated May have diabetic-type complications

Medical Interventions No cure for diabetes Glucose monitoring Medication ◦Type I – insulin ◦Type II – oral medications or insulin Lifestyle – diet and exercise Type II diabetics can slow progression or reverse effects of their disease by maintaining a healthy weight

What is Social Marketing? Essentially began in 1792 Used to inform the American public of governmental initiatives, proposed laws, legislation and policy The term “Social Marketing” ◦Created by Kolter and Zaltman in 1971 ◦Defined as:  “the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence voluntary behavior to target audiences in order to improve their personal welfare and that of their society” (Andreasen 1995, pg. 7)

What is Social Marketing? Designed to benefit individuals or a society It is a bottom-up approach Consumer-centered approach Limits: ◦Not effective on genetic or addictive disorders Strengths: ◦Effect on helping people sustain healthy, behavior change

Principles of Social Marketing The Marketing Conceptual Framework Recognition of the Competition Consumer Orientation Formative Research Segmentation of the Population Feedback and Evaluation

Current Social Marketing “Sunny Side of Truth” ◦Anti-smoking campaign “Above the Influence” ◦Anti-drug campaign

Social Marketing and Diabetes Benefits: ◦Weight loss, reduced stress, lower risk of stroke and heart disease, patient empowerment, increase self-esteem and increased life expectancy What does it cost to the individual? ◦Change old habits ◦An alternative to fast food Promote healthy lifestyles by using flyers, television and radio

What is Motivational Interviewing? Defined as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” Initially developed by William Miller in 1983 to help problem drinkers, and was further developed in 1991 by clinical psychologists Professor Bill Miller and Professor Stephen Rollnick. Non-judgmental, non-confrontational and non- adversarial.

Motivational Interviewing con’t Through the MI technique, counselors attempt to raise their clients’ awareness of risks and consequences of the behaviors they wish to change. Using directive communication, counselors attempt to help clients envision a better future and achieve behavior changes. Components of MI include: - seeking to understand the client’s frame of reference - expressing affirmation - reinforcing the client’s own motivational desire - monitoring the client’s readiness to change - affirming client’s freedom and self-direction

Decisional Balance Tool STAY THE SAMEMAKE SOME IMPROVEMENT BENEFITSI like:I will like: COSTSI don’t like:I won’t like: What specific behavior change are you considering?_____________________

Does it work? Trial results 227 subjects, all in diet/exercise program Randomized to 2 groups: MI or an attention placebo After 2 sessions, MI group had greater weight loss (5.4kg versus 3.9kg) After 12 months, MI group maintained greater loss (4.7kg versus 2.7kg) MI group also demonstrated better glycemic control More studies being conducted, one to be completed in 2008

Conclusion…. Social Marketing and Motivational Interviewing may have a positive impact on the health outcomes of a population struggling with diabetes and possibly other behavior-related chronic diseases.

THANK YOU FOR YOUR TIME QUESTIONS???