Jane K. Dickinson

Correlates of Self-Efficacy in Diabetes Self-Care Among Hispanic Adults With Diabetes

PURPOSE The purpose of this study was to examine factors associated with increased diabetes self-efficacy among insulin-requiring Hispanic adults with diabetes. METHODS A cross-sectional survey design was used to obtain self-reported data on a nonrandom sample of 97 insulin-requiring Hispanic adults with diabetes. The Insulin Management Diabetes Self Efficacy Scale (IMDSES) was translated into Spanish and administered with a demographic questionnaire by trained bilingual/bicultural interviewers in each respondents own home. Factor analysis of the IMDSES revealed 4 subscales that corresponded with major diabetes self-care management behaviors. RESULTS Respondents gave low to average self-efficacy ratings on their ability to manage all aspects of their disease. Behaviors that required problem solving in changing circumstances received the lowest scores. Attending diabetes classes and having home nursing visits were associated with an increased sense of selfefficacy, particularly as it related to diet and insulin. Englishspeaking ability was associated with a general sense of selfefficacy in managing diabetes care. CONCLUSIONS The model tested was able to explain modest levels of selfefficacy, particularly in 2 of the most important diabetes management areas, insulin and diet management.

The process and rationale for an online master's program in diabetes education and management.

Purpose Although all certified diabetes educators have been required to have specific clinical training in a health discipline, graduate programs in diabetes education are relatively rare. The purpose of this article is to describe the development of a different approach to educating diabetes educators: an interdisciplinary graduate degree in diabetes education and management. In addition to preparing more diabetes educators, a graduate degree encourages existing diabetes educators to expand their area of expertise and their leadership skills. The article provides a discussion of the current trend toward interprofessional education and describes the challenges associated with mounting an online graduate program. Conclusions Those who are engaged in or seeking a career in diabetes education are interested in a graduate degree in the specialty. Such a degree offers a route into diabetes education for those who are not currently in the field as well as a method for current diabetes educators to increase their expertise and their potential for leadership. The time has come to raise the professional standard for diabetes education by providing an academic preparation for diabetes educators.

Commentary: The Effect of Words on Health and Diabetes

This article discusses the effect of words on diabetes. People with diabetes are exposed to the language health care professionals (HCPs) use, in both speaking and writing, and those words may contribute to an already stressful illness experience. Language is a significant part of every person’s context, and context shapes experience. There is evidence that words can affect responses to health-related situations and may even lead to a stress response. HCPs often discuss delivering diabetes care in an empowerment model, and so far that has not included using language that is consistent with the approach. Awareness is the first step toward identifying and changing the words HCPs use with people who have diabetes.

Building Therapeutic Relationships: Choosing Words That Put People First

As health care professionals (HCPs), what we know, do, and say has an impact on people. People with diabetes come to us when they are vulnerable, and our knowledge, actions, and words give us the power to help them overcome their fear and learn what they need to take care of themselves. Unfortunately, the words used in diabetes care often lead to shame instead. When HCPs interact with people who are diagnosed with diabetes, we often use words such as “diabetic,” “should,” “test,” “control,” “noncompliant,” and “morbidly obese.” Although these words have been part of the health care lexicon for years, many people with diabetes find them negative and judgmental and often shut down when they hear them. Negative words are not helping people better manage their disease and may even be hurting them. People with diabetes experience abundant guilt, shame, and blame. Society in general, and HCPs in particular, often refer to diabetes as a “lifestyle disease.” This alone sends a message of judgment. The literature shows that words make a difference in health (1), and some groups have already taken the initiative in changing the language used in specific health-related conditions. It is time for diabetes care professionals to do the same. The messages we send in health care can have an impact on patient-provider communication and, ultimately, relationships. Through messages that empower people with diabetes, we can build trust and rapport. This increases the likelihood that patients will communicate openly and honestly with us and listen to our suggestions. A language movement is not a new concept. Psychologists, health professionals, and even the lay community have been discussing the language of health care for more than half a century. Diabetes Australia published a position statement on language …

Diabetes Education as a Career Choice.

Purpose The purpose of the study was to examine the field of diabetes education along with identifying facilitators and barriers for future health care professionals entering the specialty field of diabetes education. Method Faculty members who were currently teaching in a health-related discipline, the students of those faculty members, and nursing students who were members of the National Student Nursing Association were surveyed to gather descriptive data. Results While faculty members reported they are promoting diabetes education to their health professions students, many nursing students are not aware of this career path. Nursing students understand that diabetes is a significant problem and will be something they encounter in all areas of their careers, but many were not sure they wanted to specialize in it. Conclusions There is a gap between what faculty members and students report as far as awareness of the diabetes education specialty. In addition, misinformation about diabetes and people living with diabetes may be a deterrent for potential future diabetes educators. American Association of Diabetes Educators, health professions faculty members, and practicing diabetes educators can do more to clear up misconceptions and promote diabetes education as a career path for students in the health professions.

The Use of Language in Diabetes Care and Education

Language is powerful and can have a strong impact on perceptions as well as behavior. A task force, consisting of representatives from the American Association of Diabetes Educators and the American Diabetes Association, convened to discuss language in diabetes care and education. The literature supports the need for a language movement in diabetes care and education. There are effective ways of communicating about diabetes. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words, whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes.

The Experience of Diabetes-Related Language in Diabetes Care

Objective. The goal of this study was to understand how adults with diabetes experience the words used in diabetes care. Methods. This qualitative study guided by Critical Theory used two virtual and two in-person focus groups conducted by the same facilitator. A total of 68 focus group members participated. The facilitator transcribed and coded focus group data using individual responses as the unit of analysis. The facilitator used constant comparison to analyze responses and developed a research summary of themes that emerged. A second coder confirmed the themes originally identified, and participants provided feedback on the summary. Results. Many negative and stigmatizing words are used in diabetes care. Several themes emerged from the data, including judgment; fear and anxiety; labels, reminders, and assumptions; oversimplification and directives; misunderstanding, misinformation, and disconnection; and body language and tone. Participants reported experiencing negative diabetes-related words in the general public, with their health care providers (HCPs), and in the media. Participants made suggestions for HCPs to replace negative words; they raised a concern that current negative words will be replaced by others with similar negative connotations; and they said they would feel more like a partner in their care if HCPs stopped using these words. Conclusion. The language used in diabetes care has an impact on people who live with the disease. Awareness is the first step in eradicating stigma in diabetes care. HCPs can improve patient-provider communication and contribute to a more positive experience for people living with diabetes by choosing words that empower.

The 2017 Diabetes Educator and the Diabetes Self-Management Education National Practice Survey:

Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about factors influencing the work of the diabetes educator. Method The 2017 NPS was comprised of 100 questions covering diabetes educator demographics, profile populations of people with diabetes, practice information, program accreditation, program curriculum, staffing, education delivery methods, data collection, and reporting. The basic survey consisted of 22 questions using branch logic, from which respondents were then directed to questions tailored to their particular practice setting, enabling them to answer only a relevant subset of the remaining questions. The web-based survey was sent to approximately 32 000 individuals who were either members of the American Association of Diabetes Educators (AADE) or Certified Diabetes Educators (CDE) with the National Certification Board for Diabetes Educators (NCBDE) but not AADE members. Weekly reminder e-mails were sent to recipients who had not yet responded. The outreach efforts resulted in the survey being completed by 4696 individuals, a 17% response rate yielding 95% confidence that these responses are within ±5% accuracy. Results Diabetes Self-Management Education and Support (DSMES) continues to be a field dominated by women (95%). Diabetes educators represent a diverse health care profession, with educators indicating most commonly that their primary discipline is nursing (48%), nutrition (38%), and pharmacy (7%). When asked about credentials, 82.6% indicated that they held a CDE, 3.8% held the Board Certified-Advanced Diabetes Management (BC-ADM) credential, and 16.5% held neither the CDE nor the BC-ADM. Nearly 75% characterized their role as a diabetes educator as providing direct patient care. DSMES continued to be provided in a varied array of settings to educationally, socioeconomically, and racially diverse patient populations. DSMES was delivered using a number of different educational strategies. Diabetes educators have direct influence in care and services that people with diabetes receive. Conclusions The results of the 2017 NPS demonstrate that diabetes educators are meeting the needs of varied populations in various practice settings. They are working with individuals with type 1 and type 2 diabetes, those at risk for diabetes, and women with gestational diabetes and are involved in recommending, implementing, and providing key referrals and recommendations for diabetes care, including insulin initiation, titration, medication adjustments, recommendations on devices, and technology. Identified areas for improvement include needs for increased racial and ethnic diversity in the workforce, recruiting young professionals, drawing practice approaches from related disciplines (eg, mental health and disability rehabilitation), and encouraging tracking of more areas of outcomes data. Diabetes educators are playing an increasingly central role within multidisciplinary care teams with people at risk for diabetes, those who have diabetes, and those with other chronic conditions.