PSYCHO-SOCIAL ASPECTS OF

DIABETES MANAGEMENT

Barbara Dale L.C.S.W. Clinical Director,

Visiting Nurse Health System, Long Term Care at Home

and

Karen Watkins, PhD., L.M.S.W.

Clinical Assistant Professor, School of Social Work Georgia State University

Overview

Psychosocial Factors

Review of Evidenced-Based Diabetes

Self-Management Interventions/Programs (DSME)

Case Management

Community

Motivational Interviewing

Motivational Interviewing Techniques

Community Resources

Psychosocial Factors of Older Adults with

Diabetes

Depression Symptoms

Cognitive Decline

Low Social Support

Major Stressful Life Experiences

Living in Urban versus Rural Environments

Cultural implications

Economic Resources

Stress and anxiety

Educational/ literacy levels

Protoplasmix.wordpress.com

(Bertera, 2006; DeCoster, 2001, 2009; Funnell et.al. 2007; Hewitt et.al 2010; Ling & Boey 2000; Lustman, 2000;

Lustman & Clouse, 2004; Lustman et. al., 2000; Trief et.al, 2006; Schillinger et.al 2002 etc.)

Evidenced Based

Self-Management Interventions

Community

Social Support

Networks

Adult Day Care

Diabetes Club

Focus Groups

Psychoeducational

Groups

Case Management

Community Health Worker

Home Health

Mental Health

Videophone

Telephonic

Community Interventions

Social Support Networks

Adult Day Care

Diabetes Club

Focus Groups

Psychoeducational

Health.com

(Bertera, 2003; Cheng & Boey, 2000; Dabelko & DeCoster, 2007; DeCoster & George 2005; Lisbeth et. al.,

2011; Trozzolino, et.al., 2003)

Case Management Intervention

Community Health Worker

Chronic Disease

http://patienteducation.stanford.edu/programs/diabeteseng.html

Home Health

Mental Health

Videophone

Telephonic

Casemanagementstlouis.com

(Garrelts et.al. 2010; Hawkins, 2010; Lee, 2004; Leeman et.al. 2008; Skelly, 2010; Spencer et.al 2008)

MOTIVATIONAL

INTERVIEWING

Evidenced-Based Approach to Behavior Change

Motivational Interviewing

“… a collaborative, person-centered form of

guiding to elicit and strengthen motivation for

change.”

Developed by William Miller 1983

www.motivationalinterview.org

Motivational Interviewing and Healthcare

Motivational Interviewing and Older Adults

Motivational Interviewing and Diabetics (Chen et.al, 2012; Cummings et.al., 2009; El-Mallakah et.al, 2012; Hunt, 2011; Miller & Rollnick, 2002; Minet

et. al 2011; Ridge et. al. 2012; Rubak, 2009; Welch et. al. 2006; Welch et.al. 2010)

No Time for Listening

Brief, Practical Medical Interventions

Effective discussion on front end can reduce

headache on back end

Increase success with “non-compliant” patients

Increase levels of “change talk” and decrease

resistance to change

Well-intended suggestions fall on deaf ears

The Visit http://www.youtube.com/watch?v=80XyNE89eCs

http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html

Based on her conversation with the

MD, is she likely to stop smoking ?

1___2___3___4__5___6___7__8__9__10___

1= not at all 10= absolutely

Stages of Behavior Change

Precontemplation

”I don’t have a problem”

Contemplation

“I know I should change”

Preparation

“I’m taking steps to do something soon”

Action

I’m doing it!!”

Maintenance

“I’ve been doing it for at least 6 months!”

Relapse

”OOPS!”

Stages of Behavior Change

http://well-fitbodies.com/yahoo_site_admin/assets/images/Stages_of_Change.23130956_std.JPG

MI Techniques

Ask permission to discuss issue “You’ve been

having these worrisome lab results, can we discuss

this ?”

Reflective listening Say back what you hear them

saying; focus on ambivalence

Ask open-ended questions “What might your life

look like without this change?”

Elicit a response “What do you know about..”

Give affirmation “This is really hard” (use scale)

Summary of conversation and interventions

wrmtraining.com

Scale of Change

Assess “Readiness”, “Confidence” and,

“Importance” of change by using scale

1___2___3___4__5___6___7__8__9__10___

1= not at all 10= absolutely

MI Techniques in Action Motivational Interviewing-Evoking a Commitment to Change

http://www.youtube.com/watch?v=dm-rJJPCuTE

http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html

GUIDE/INSTRUCTOR/LISTENER

The Guide- asking open ended questions to raise doubt and help patients make informed decisions(“What might your life look like if you don’t make these changes?”)

The Instructor- being more directive when the time is right

The Listener- gathering information about the patient’s situation; focusing on their ambivalence

socialmediagovernance.com

DARES Principles

Develop Discrepancy-patient should present arguments for change

Avoid Argumentation-back off if too much resistance

Roll with resistance- try to understand where they are coming from (“I hate these meds”; “It hurts giving myself shots”)

Express empathy- reflective listening

Support self-efficacy- support ability to change and build confidence

Miller WR, Rollnick S. Motivational Interviewing, Second Edition: Preparing People for Change. New York: Guilford Press; 2002.

Effective Physician Video http://www.youtube.com/watch?v=URiKA7CKtfc

http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html

Community Resources

National

American Association of Diabetes Educators www.diabeteseducators.org

American Diabetes Association- www.diabetes.org

Area Agency on Aging – National Website www.aaaphx.org/

National Center for Chronic Disease Prevention and Health Promotion –

www.cdc.gov/nccdphp

National Diabetes Educational Program- www.ndep.nih.gov

National Institute on Diabetes and Digestive and Kidney Diseases-

www.niddk.nih.gov

State

Area on Aging-

http://www.georgiaservicesforseniors.org/Default.aspx#OutputAnchor

Atlanta Regional Commission Age Wise - www.agewiseconnection.com

Community Care Services Program (CCSP) 404-463-3333

GA Area Agencies on Aging- http://www.georgiaservicesforseniors.org/

Service Options Using Resources and Community Environments (SOURCE)

(404) 463-3248 www.payingforseniorcare.com/

http://www.georgiaservicesforseniors.org/

Community Resources cont.

Local

Atlanta Medical Hospital- (404)265-4000 www.atlantamedicalcenter.com/

DeKalb Medical Center- (404) 501-1000 www.dekalbmedical.org

Diabetes Association of Atlanta (Multiple Support Programs) www.diabetesatlanta.org

Emory Healthcare System- (404) 778-7777 www.emoryhealthcare.org/

Grady Diabetes Clinic- Main: (404)616-3731 Pharmacy: (404)616-5500 www.gradyhealth.org/

Piedmont Hospital: Sixty Plus Older Adult Services- (404) 605-3857 www.piedmonthospital.org

Project Open Hand - Meal Program (Numerous)- (404) 872-6947 www.projectopenhand.org

United Way- (211) www.211online.unitedwayatlanta.org

Mental Health for Older Adults (Local)

Anchor Hospital (Supportive Care Unit)- (770) 991-6044 www.anchorhospital.com

Emory Wesley Woods Center-(404) 728-6200 www.emoryhealthcare.org/senior-health-center/index.html

GA Crisis Line - 1-800-715-4225 www.mygcal.com

National Alliance on Mental Illness (NAMI) – www. nami.org

Peach ford Hospital- (770) 455-3200 www.peachfordhospital.com

Ridgeview Institute-(770) 434-4567 http://www.ridgeviewinstitute.com/pat_serv_senior.htm

Summit Ridge (Senior Adult Inpatient Program)- (678) 442-5800 www.summitridgehospital.net

Other Resources

Stanford Chronic Disease Self-Management Program - Diabetes specific http://patienteducation.stanford.edu/programs/diabeteseng.html

WIC Works Resources-Sample MI statements and questions. www.nal.usda.gov/wicworks/WIC_Learning.../questions_MI.pdf

Questions and Answers

Feel free to ask any questions or add comments!

References

Alberti G. The DAWN (Diabetes Attitude, Wishes and Needs) study. Practical Diabectology International. 2002; 19(1): 22-24.

Bertera E. (2003). Psychosocial factors and ethnic disparities in diabetes diagnosis and treatment among older adults. Health and Social Work; 28(1) 33-42.

Chen, Shu Ming, Creedy D, Lin Huey, & Wollin J. (2012). Effects of motivational interviewing intervention on self- management, psychological and glycemic outcomes and Type 2 Diabetes: randomized controlled trial. International Journal of Nursing Studies, 49(6):367-644.

Cummings S, Cooper R, & Cassie K. (2009). Motivational interviewing to affect behavioral change in older adults. Research on Social Work Practice, 19(2):195-204. dio: 10.1007/s10461-011-0016-x

Dabelko H &DeCoster V. (2007). Diabetes and Adult Day Health Services. Health & Social Work, 32(4)279-288.

DeCoster , V. (2001). The psychosocial challenges of Type 2 Diabetes and the roles of health care social work: A neglected area of practice. Health & Social Work, 26, 26-37.

DeCoster, V. & Cummings, S. (2005). Helping adults with Diabetes: A review of evidence based interventions. Health & Social Work, 30, 259-264.

DeCoster V. (2009). Diabetes treatments. Cummings S and N Kropf (Eds.) Handbook of Psychosocial Interventions with Older Adults: Evidence- Based Approaches. New York, NY. Routledge/ Taylor & Francis Group.102-125. dio:10.1080/01634370802137843.

DeCoster V. & George, L. (2005A). A community based self-help intervention of elders living with Diabetes. The Journal of Educational Gerontology, 31, 699-713.

DeCoster V. & George L. (2005)B. An empowerment approach for elders living with Diabetes: A pilot study of community-based self- help group: The Diabetes Club. Educational Gerontology, 31(9): 699-713.

References

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References

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