1. Health education relating to diabetes Ann MacLeod, RN, BScN, MPH

2. A. MacLeod. Fall 20022

3. 3 One minute paper Think of the last time you tried to adopt a healthier behaviour. What motivated you to change? What helped, what hindered?

4. A. MacLeod. Fall 20024 Levels of Prevention w Primary - before a disease develops w Secondary - screening, early identification w Tertiary - preventing more serious complications from an identified condition

5. A. MacLeod. Fall 20025 Stages of Change, Prochaska and DiClemente w Precontemplation w contemplation w preparation w action w maintenance

6. A. MacLeod. Fall 20026 Precontemplation w “ it isn’t that they can’t see the problem, they can’t see the solution” “ I can’t be bothered trying to control my sugars.” w No intention to change behavior w resistance to recognizing or modifying a behavior

7. A. MacLeod. Fall 20027 Patient and Nursing w “eating chocolate is the only pleasure I get” w Patient may feel rebellion, need to share info, demoralized, Dr will not spend time w Work on developing rapport w “tell me about, …” encourage change to talk w give factual, motivating information

8. A. MacLeod. Fall 20028 Contemplation w “Knowing where you want to go but not quite ready” w know problem but not quite made commitment but within 6 months w weighing of pros and cons of problem, impact on others and solutions to it

9. A. MacLeod. Fall 20029 Patient and Nursing w Guilt, profound ambivalence, procrastinator w here are the tools to make it easier for you w provide networking w “ here are the complications of uncontrolled diabetes, but we can help you control them”

10. A. MacLeod. Fall 200210 Preparation w Planning to change in next 30 days w taking some small steps of cutting down behavior, investigating some programs

11. A. MacLeod. Fall 200211 Patient and Nurses w Decision to try on behavior w “ I think I can control my diet, but I don’t know how to give a needle. ” w LOC, self-efficacy, positive reinforcement, follow up visits, tools to help, iron out logistics w “how can I help?” “Can you show me how you use your glucometer and needles?”

12. A. MacLeod. Fall 200212 Research studies w Researchers found that key is timing change to correct stage independent of treatment ie counselling, peer programs w for smoking success (@6mos) was w - precontemplators 22% w - contemplators 43% w - preparation or action 76%

13. A. MacLeod. Fall 200213 Action w Currently, practicing change but transition within last six months w a difficult time as takes energy but self- liberation and autonomy to change lives w “I am really working hard to change”

14. A. MacLeod. Fall 200214 Patient and Nursing w Intense time with new behavior, high risk for relapse w lots of support, external recognition, follow up meetings, behavior change and long term benefits “what things are you seeing different” “ your sugars are being well controlled.”

15. A. MacLeod. Fall 200215 Relapse w “tell me about what happened” w “what were the elements of relapse” w “reflect on what you valued to start in the first place”

16. A. MacLeod. Fall 200216 Maintenance w Work to prevent relapse and consolidate the gains beyond six months of action phase w “I may need some help right now to maintain changes” w development of alternate coping strategies

17. A. MacLeod. Fall 200217 Patient and Nurses w Rewards still very important w “do you find it easier to maintain changes” w “what ways to increase your activity are working for you?” w “ what are your rewards for keeping your sugars regulated?”

18. A. MacLeod. Fall 200218 Important Steps for Change w 1. Clearly assess patient’s stage w Nurse, “Tell me where you are at about dealing with your diabetes.” w 2. Tailor interventions accordingly

19. A. MacLeod. Fall 200219 Enhancing Motivation w Elicit client’s concerns w emphasize personal choice and responsibility for future behavior w treatment goals and strategies are negotiated based on info and acceptability w express and reflect client perceptions

20. A. MacLeod. Fall 200220 Enhancing motivation cont’d w Positive reinforcement w support continued exploration of the problem and solutions w reinforce goal identification and attainment w help pt to move forward “How would like things to turn out for you?”