Joan M. Heins

Healthy Coping: Issues and Implications in Diabetes Education and Care

Psychological, emotional, and social factors not only impact quality of life, but also often play a role in chronic illness outcomes. Diabetes care, in particular, is greatly influenced by psychosocial factors when they hinder a persons ability to manage the disease and achieve metabolic control. Healthy coping, defined as responding to a psychological and physical challenge by recruiting available resources to increase the probability of favorable outcomes in the future, is essential to effective self-management by people with diabetes. In June 2009, the American Association of Diabetes Educators convened a multidisciplinary expert panel to discuss healthy coping in diabetes. The panel included diabetes educators and behavioral science and mental health professionals. Drawing on their knowledge and experiences, as well as information presented at the symposium, the panel probed several aspects of healthy coping including what it entails, common barriers, assessment, population diversity, and clinical applications. A team approach to addressing the patients coping is critical. Team involvement relieves the diabetes educator of the entire burden of supporting the patient in this regard. The team should be broadly defined and include those who are formally and informally involved. Healthy coping is a complex, qualitative behavior that cannot be easily quantified. Future efforts to address the issue of healthy coping should add to the body of literature regarding diabetes self-management at the individual and population-based levels.

Establishing and Sustaining State-of-the-Art Diabetes Patient Education Programs: Research and Recommendations

Frequently, diabetes educators in hospitals report meeting severe organizational barriers when attempting to implement advances in diabetes patient education (DPE ). This paper reports on how eight successful diabetes patient education programs coped with potential barriers. The results are based on interviews of professionals who played central roles in introducing and sustaining the programs. Many of the identified problems centered around two issues — acquiring needed resources and communicating about the program to a variety of key groups.

Expanding Roles and Opportunities for Dietetics Practitioners in Diabetes Prevention and Care: Reflection on the Past, Speculation for the Future

● he evolution and expansion of roles for dietetics practitioners in diabetes care continues to unfold. This editorial reflects on the role of registered dietitians RDs) in diabetes care and in advancing medical nutrition herapy (MNT). To speculate on the future, current roles eld by RDs in diabetes care are dovetailed with trends nfluencing dietetic practice and society. Readers are proided with strategies to prepare and position themselves or successful careers.

CHAPTER 8 – Tools and Techniques to Facilitate Eating Behavior Change

This chapter discusses the tools and techniques for applying education and behavior change theories in the practice of medical nutrition therapy. The process of implementing medical nutrition therapy is not as straightforward and is based on thorough assessment of each clients lifestyle, capabilities, and motivation to change. Todays nutrition counselor must draw on knowledge from the biomedical and behavioral sciences to define the nutrition prescription and design an intervention that can truly impact eating. The traditional model for delivery of nutrition interventions is an individual consultation in health care settings. Moreover, increased focus on chronic disease prevention has resulted in an enhanced need for nutrition education at a time when economic constraints in health care have led to a decline in traditional hospital-based nutrition counseling services. The challenge in clinical nutrition is to prevent or treat disease by changing peoples eating habits. Research on nutrition education is extensive but not conclusive. There is consensus on two elements: (1) Education needs to be tailored to the individuals learning needs and (2) both education and behavior change tech- niques are necessary. Understanding factors that influence the learning and behavior change processes enables better selection of educational tools and techniques to make counseling more effective. The stages of change model is a useful technique for tailoring education to the individual and applying behavior change strategies.

Chapter 10 – Tools and Techniques to Facilitate Nutrition Intervention

To effectively facilitate nutrition interventions and medical nutrition therapy, dietitians must understand the teaching–learning process and conduct individualized assessments of learning style and motivational readiness so they can determine which tools and techniques are most appropriate to help patients make healthy changes in eating behavior. This chapter reviews (1) the various factors that affect the teaching–learning process, and the different domains in which people learn; (2) nutrition education techniques and the process that nutrition counselors use to assess learning needs, determine the level of education, and select the educational method and tools that match the patient’s needs; and (3) the stages of change model and how it can guide the nutrition counselor in selecting behavior change techniques that are tailored to an individual patient’s level of motivational readiness. Case scenarios demonstrating how the counselor might apply these approaches offer examples of how to phrase the counseling dialogue.