teaching diabetes self-management
TRANSCRIPT
TeachingDiabetesSelf-Management—in4Hours(orLess)
h=p://bit.do/b3SSy
LindaSGo*redson,PhD
SchoolofEduca7onUniversityofDelaware
KathyStroh,MS,RD,CDEDiabetesPreven7onandControlProgram
DelawareDivisionofPublicHealth
1
CEHDColloquium,UniversityofDelaware,February28,2013
Juvenile Diabetes Maturity-onset Diabetes Insulin dependent Non-insulin dependent Diabetes (IDD) Diabetes (NIDD)
Type I Diabetes Type II Diabetes Type 1 Diabetes Type 2 Diabetes
Types of Diabetes
2
Types of Diabetes (DM)
Type 1 β-cell destruction; autoimmune disease; complete lack of insulin 5-10% of total patients
Type 2 β-cell dysfunction and insulin
resistance Gestational β-cell dysfunction and insulin
resistance during pregnancy
3
There is no such thing as Borderline Diabetes
or a “Touch of Diabetes.”
Pre-diabetes is a diagnosis.
4
There is no such thing as Borderline Diabetes
or a “Touch of Diabetes.”
5
Pre-diabetes
DM defects
6
Diabetes is a cardiovascular disease.
The Burden of Diabetes in Delaware, 2009. Diabetes Prevention and Control Program
People with diabetes are
twice as likely
to suffer a heart attack
or stroke
compared to people without diabetes.
7
NaturalhistoryofType2diabetes
Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota.
Obesity Diabetes Uncontrolled Hyperglycemia
50 100 150 200 250 300 350
50
100
150
200
250
Glu
cose
(m
g/dL
) R
elat
ive
Func
tion
(%)
-10 -5 0 diagnosis
5 10 15 20 25 30 Years of Diabetes
Post-meal Glucose
Fasting Glucose
Insulin Resistance
Insulin Level β-cell Failure
Insulin Resistance Family History
Prediabetes
Whyteachself-management?
• PaXentsmustcontroltheirbloodglucose(BG)levelstoavoidcomplicaXons
• ControllingBGisacomplex,24/7,life-longtask– Rx’schange,increase;maynotinsureopXmalBGcontrol– Changesindietaryintake&physicalacXvitynecessary– Andmore…
• Somuchtolearnanddo(orstopdoing)
9
PWD’s*everydayreality
* “Diabetic” is not a noun 10
11
12
13
As teacher educators, how would you recommend
teaching diabetes self-management?
Here’s the challenge
14
Privateschools
0.4milteachers5.4milpupils
$673 billion
15Federal
State
District
Federal
State
District
Regulations
Publicschools
3 million 50 million
Diabeteseduca7on??
$673 billion
16Federal
State
District
Federal
State
District
Regulations
Publicschools
3 million 50 million
InstrucXonLearningtasks
Privateschools
0.4milteachers5.4milpupils
Diabeteseduca7on??
Context:Explodingnumbers
12012Condi*onofEduca*on,TableA-3-1.h=p://nces.ed.gov/pubs2012/2012045_5.pdf2For1970,AllAgesisinterpolatedfrom1968and1973.h=p://www.cdc.gov/diabetes/staXsXcs/diabetes_slides.htm.3For1990and2010,Allagesand65+derivedfromh=p://www.cdc.gov/diabetes/staXsXcs/prev/naXonal/tnumage.htm,and18+fromh=p://www.cdc.gov/diabetes/staXsXcs/prev/naXonal/figadults.htm4Boyleetal(2010),ProjecXonoftheyear2050burdenofdiabetesintheUSadultpopulaXon.Popula*onHealthMetrics,8(29).Iaveragedtheresultsfromtheir4models.Huangetal.(2009)esXmated34.2MforType2alone:UsingclinicalinformaXontoprojectfederalhealthcarespending.HealthAffairs,28(5),w978-990.5CDC’sDiabetesData&Trends.h=p://apps.nccd.cdc.gov/DDT_STRS2/NaXonalDiabetesPrevalenceEsXmates.aspx,
Just5years!
Publicschools DiabetescasesNumberneedinginstruc7on
Millionsenrolled1 MillionsdiagnosedwithdiabetesType1or2(non-insXtuXonalizedcivilians)
FallofTotal
Elementary(preK-8)HS(9-12)
197045.532.513.0
199041.229.911.3
201049.534.614.9
202052.737.315.4
Allages
Adults(18+)Older(65+)
197023.6
199036.66.62.8
2010320.920.77.8
2020433.5
2004%diagnosedadults>20years52009
17
Average$/person2 4,310 7,925 10,694(2008)
11,093 6,745 1,834 466
Context:Explodingcosts
12011DigestofEduca*onSta*s*cs,Table28,h=p://nces.ed.gov/programs/digest/d11/tables/dt11_028.asp.Tablereportscostsincurrentdollars,soinflaXoncalculatorusedtobringupto2010values.22011DigestofEduca*onSta*s*cs,Table194,h=p://nces.ed.gov/programs/digest/d11/tables/dt11_194.asp3Dalletal.(2010).Theeconomicburdenofdiabetes.HealthAffairs,29(2),exhibit4.UsedinflaXoncalculatortotranslatedollarsfrom2007to2010.h=p://www.usinflaXoncalculator.com4Huangetal.(2009)UsingclinicalinformaXontoprojectfederalhealthcarespending.HealthAffairs,28(5),w978-990.IncludesType2only.Type1wouldbe<5%ofcasesbuthigherpercapitacost.InflaXoncalculatorusedtochangecostsfrom2007to2010dollars.5No2020-2030projecXonsavailableforschoolexpenditures,sojustrepeated%GDPfromtheprior2decades.UsedHuangetal.’stotaldiabetesmedicalcostsfor2007,togetherwith2007GDP,tocalculatecostsas%GDPinthatyear(1.1%).ThenusedtheirExhibit3(projectedrealgrowthasmulXpleofGDP)toesXmate%GDPin2010,2020,and2030.Nodatapriorto2007,sojusttooklinetowardasymtope.
Studentsinpublicschools,K-12 Diabetescases,diagnosedandundiagnosedTotalexpenditures(2010dollars)
Medicalcostsonly(2010dollars)
1970 1990 2010 20073 20204
Total$(billions)1
270
415
673
Type111
Type2111
Undiag12
Pre-diab27
Total160
Type2237
0.0
5.0
10.0
15.0
1970 1980 1990 2000 2010 2020 2030
Costsas%ofGDP1,5
Diabetes
Schools
18
Totalmedicalcosts,byage&diabetestype,2007
$(billions)
25.3
105.7
11.0
10.5
Dalletal.(2010).Theeconomicburdenofdiabetes.HealthAffairs,29(2),exhibit4.2007currentdollars. 19
%(prevalence)
3,567
4,775
6,387
8,198
11,722
3,837 3,7144,561
5,077 5,359
9,061
5,425
1,3742,327 2,063
4,763
579210 305 391 488 537 716
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
18–34 35–44 45–54 55–59 60–64 65+
Type1Type2UndiagnosedPre-diabetes
Ages:
Average
35,365
Averagecost($)
Averagemedicalcostsperpersonbyage&diabetestype,2007
Dalletal.(2010).Theeconomicburdenofdiabetes.HealthAffairs,29(2),exhibit4.2007currentdollars.20
Context:InsXtuXonalresources
Publicschools Diabetesself-managementeduca7onDedicatedspace Permanentbuildings Varies;hospitals,medicaloffices,communitysites
Guaranteedfunding 100%tax-supported1(local,state,federal)
Variesbyhealthplan;freecommunityclassesprovidedbyDPH/DPCP.
Mandatorya_endance 10-14years None,allvoluntary.~24%ofMedicarepaXentsa=endedDSMTclass.
Teachingforce:
TrainedincontentareaCerXfiedtoteach
ClassroomteachersAll(N=3.1million)199%1
ManystaffdoDSME:medical(e.g.,MD,RN,RD,NP,PA,RPh);non-medical(e.g.,CHW,CHES,peereducators).DSMPclassesgivenbylaytrainers.Trainedindiseasemanagement:MD,RN,RPh,RD,NP,CDE.Trainedtoeducate:OnlyCDEs(N=8710),naXonalcredenXal;possiblestatelicensuretoo.
Curriculumcontent&
Teacherlessonplans
StatenaXonalstandards(CCSS2)Always.Varybyteachercommonplanning
Curriculumcontent:ADAandAADEcerXfyRecognizedPrograms.DSMPhasevidence-basedcurriculum.Lessonplans:varywithADA&AADEprograms.FidelityagreementforDSMP.
12012Condi*onofEduca*on,TablesA-19-1(2008-2009),A-17-1&A-17-2(2007-2008)2h=p://www.corestandards.org/
=trendtowards
21
MorevariableforDSME
5levelsofdiabeteseducators*o Level1,non-healthcareprofessional,o Level2,healthcareprofessionalnon-diabeteseducator,o Level3,non-credenXaleddiabeteseducator,
v Level4,credenXaleddiabeteseducator,andv Level5,advancedleveldiabeteseducator/clinicalmanager.
*AmericanAssociaXonofDiabetesEducators(AADE)(2011).ScopeofPrac*ce,StandardsofPrac*ce,andStandardsofProfessionalPerformanceforDiabetesEducators,p.4.h=p://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/ScopeStandards_Final2_1_11.pdf 22
Context:InstrucXonalresourcesop0 Publicschools Diabetesself-managementeduca7on
Hoursofinstruc7onincontentarea(averageperyear)
State/district-mandatedminimumhours:1G1-4:418read/write194math292science
Variesgreatlybyhealthplan&site-Classes:10-15hrs-IndividualDSME:varies
Instruc7onalstrategies SystemaXcuseofpedagogicalprinciples
ForindividualpaXents:CDE’sassessmentofpaXent’sneeds.Forgroups:scriptsforsomenon-medicaleducators(e.g.,DSMP)Pace,sequencing,Bloomlevelnotalwaysconsidered.
SpecialneedsstudentsEstablishedprotocols?
Yes,legalobligaXon(IDEA)
Currently,noDSMEmaterialsorcurriculaspecificallyforelderlyorpersonswithdisabiliXes.
Age-andability-differen7atedinstruc7on&materials
Agegrouping,preK-12Elem:reading/mathgroupswithinorbetweenclassrooms,allwithdifferentlessonsHS:Tracks
None.Growingconcernoverlow“healthliteracy”&age-relatedcogniXvedeclinewithPWDs,but-DiabeteseducaXonmaterialsvarywidely;content,butnotcomplexity,matchedtoPWD’slearningneeds.-PWDsaregivenpre-determinedmetersandsupplies,regardlessoftheirabiliXes.
1Datafor2003-2004.Source:“ChangesinInstrucXonalHoursinFourSubjectsbyPublicSchoolTeachersofGrades1Through4,“May2007,NCESreport2007-305h=p://www.eric.ed.gov/PDFS/ED497041.pdf/2h=p://www.cdc.gov/diabetes/staXsXcs/prevenXve/tNewDEduAgeTot.htmwww.eric.ed.gov/PDFS/ED497041.pdf
23
Li_ledifferen7a7on
Limited7me
Materialstoocomplex
ExampleofrequiredtaskforallPWDs:
Glucosemeters
andlancetdevices
24
Ourefforts
1. Describejobofself-carefrompa7ent’sperspec7ve.– Collabora7onwithCDS:AUCDConference– AADEConference:“Cogni7veDemandsofDSME”
– NACDDTeleconference:“Cogni7veDemandsofDSME”
– AADEConference2013:“PsychometricsofDSMEintheElderly”
2. IdenXfythejob’smostcriXcaltasks
3. Trace(andlimit)cogniXvecomplexityoflearningtasks
4. DifferenXateinstrucXonbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. ProvidepaXenthandoutthatreinforceslearning
25
AADE’sdescripXonofDSM*LivingwellwithdiabetesrequiresacXve,diligent,effecXveself-managementofthedisease.Itisaprocessthat:
• RequiresmakingandacXngonchoices,onaregularandrecurringbasis,thataffectone’shealth
• IncludesØ learningthebodyofknowledgerelevanttothediseasestate,Ø definingpersonalgoals,weighingthebenefitsandrisksofvarioustreatmentopXons,Ø makinginformedchoicesabouttreatment,Ø developingskills(bothphysicalandbehavioral)tosupportthosechoices,Ø evaluaXngtheefficacyoftheplantowardreachingself-definedgoals.
*AmericanAssociaXonofDiabetesEducators(AADE)(2011).ScopeofPrac*ce,StandardsofPrac*ce,andStandardsofProfessionalPerformanceforDiabetesEducators,pp.1-2.h=p://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/ScopeStandards_Final2_1_11.pdf 26
AADE’sdescripXonofDSM*LivingwellwithdiabetesrequiresacXve,diligent,effecXveself-managementofthedisease.Itisaprocessthat:
• RequiresmakingandacXngonchoices,onaregularandrecurringbasis,thataffectone’shealth
• IncludesØ learningthebodyofknowledgerelevanttothediseasestate,Ø definingpersonalgoals,weighingthebenefitsandrisksofvarioustreatmentopXons,Ø makinginformedchoicesabouttreatment,Ø developingskills(bothphysicalandbehavioral)tosupportthosechoices,Ø evaluaXngtheefficacyoftheplantowardreachingself-definedgoals.
*AmericanAssociaXonofDiabetesEducators(AADE)(2011).ScopeofPrac*ce,StandardsofPrac*ce,andStandardsofProfessionalPerformanceforDiabetesEducators,pp.1-2.h=p://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/ScopeStandards_Final2_1_11.pdf
WhatBloomlevelwouldyouassigntoeach?• Remember• Understand• Apply• Analyze• Evaluate• Create 27
AADE7TMcurriculumcontent
1. HealthyeaXng2. BeingacXve3. Monitoring4. TakingmedicaXon5. Problemsolving6. Reducingrisks7. Healthycoping
Objec7ve:Maintainbloodglucosewithinhealthylimitstoavoidcomplica7ons
• Learnaboutdiabetesingeneral(At“entry’)– Physiologicalprocess– Interdependenceofdiet,exercise,meds– Symptoms&correcXveacXon– Consequencesofpoorcontrol
• Applyknowledgetoowncase(Daily,Hourly)– Implementappropriateregimen– ConXnuouslymonitorphysicalsigns– DiagnoseproblemsinXmelymanner– Adjustfood,exercise,medsinXmelyandappropriatemanner
• Coordinatewithrelevantpar7es(Frequently)– NegoXatechangesinacXviXeswithfamily,friends,job– Enlist/capitalizeonsocialsupport– CommunicatestatusandneedstopracXXoners
• Updateknowledge&adjustregimen(Occasionally)– WhenotherchroniccondiXonsordisabiliXesdevelop– Whennewtreatmentsareordered– Whenlifecircumstanceschange
• Condi7onsofwork—24/7,nodaysoff,nore7rement
OurmorepaXent-centeredjobdescripXon
Self-
management
Training
28
Objec7ve:Maintainbloodglucosewithinhealthylimitstoavoidcomplica7ons
• Learnaboutdiabetesingeneral(At“entry’)– Physiologicalprocess– Interdependenceofdiet,exercise,meds– Symptoms&correcXveacXon– Consequencesofpoorcontrol
• Applyknowledgetoowncase(Daily,Hourly)– Implementappropriateregimen– ConXnuouslymonitorphysicalsigns– DiagnoseproblemsinXmelymanner– Adjustfood,exercise,medsinXmelyandappropriatemanner
• Coordinatewithrelevantpar7es(Frequently)– NegoXatechangesinacXviXeswithfamily,friends,job– Enlist/capitalizeonsocialsupport– CommunicatestatusandneedstopracXXoners
• Updateknowledge&adjustregimen(Occasionally)– WhenotherchroniccondiXonsordisabiliXesdevelop– Whennewtreatmentsareordered– Whenlifecircumstanceschange
• Condi7onsofwork—24/7,nodaysoff,nore7rement
OurmorepaXent-centeredjobdescripXon
Self-
management
Training
29
ItisNOTjustfollowingaplan.
ItisalsothinkingandacXngtominimizeproblems.
Ourefforts
1. Describejobofself-carefrompaXents’perspecXve
2. Iden7fythejob’smostcri7caltasks
3. Trace(andlimit)cogniXvecomplexityoflearningtasks
4. DifferenXateinstrucXonbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. ProvidepaXenthandoutthatreinforceslearning
30
UDsurvey:CriXcalityrankings
31
Ourefforts
1. Describejobofself-carefrompaXents’perspecXve
2. IdenXfythejob’smostcriXcaltasks
3. Trace(andlimit)cogni7vecomplexityoflearningtasks
4. DifferenXateinstrucXonbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. ProvidepaXenthandoutthatreinforceslearning
32
Bloom’sTaxonomyofLearningObjecXvesLatest(2001)revision
Bloom levels = continuum of cognitive complexity
Notjustreadability!!
33
*Revised 2001: Anderson,L.W.,&Krathwohl,D.R.(2001).Ataxonomyforlearning,teaching,and
assessing:ArevisionofBloom'staxonomyofeduca*onalobjec*ves.NY:AddisonWesleyLongman.
Tobeornottobe,thatistheques7on.
Tobeornottobe,thatistheques7on.
Tobeornottobe,thatistheques7on.
Tobeornottobe,thatistheques7on.
Tobeornottobe,thatistheques7on.
Tobeornottobe,thatistheques7on.
“Tobeornottobe”Bloom’staxonomyofeducaXonalobjecXves(cogniXvedomain)*Simplesttasks1.Remember
recognize,recall,IdenXfy,retrieve
2.Understand
paraphrase,summarize,compare,predict,infer
3.Applyexecutefamiliartask,,
applyproceduretounfamiliartask
4.AnalyzedisXnguish,focus,select,
integrate,coordinate
5.Evaluatecheck,monitor,detect
inconsistencies,judgeeffecXveness
6.Createhypothesize,plan,invent,
devise,design
Mostcomplextasks
34
*Revised 2001: Anderson,L.W.,&Krathwohl,D.R.(2001).Ataxonomyforlearning,teaching,and
assessing:ArevisionofBloom'staxonomyofeduca*onalobjec*ves.NY:AddisonWesleyLongman.
AnXcipateeffectofexercise&foodsonbloodglucose.
Coordinatemeds,diet,andexercise.
Managesickdays.
Determinewhen&whybloodglucoseisoutof
control
Monitorsymptoms;assesswhetheracXonneeded;evaluateeffecXvenessof
acXons
CreatedailyandconXngencyplansthatcontrolblood
glucose
Recalleffectsofexerciseonglucose.
RemembertotakeBGs&Rx.
Bloom’staxonomyofeducaXonalobjecXves(cogniXvedomain)*Simplesttasks1.Remember
recognize,recall,IdenXfy,retrieve
2.Understand
paraphrase,summarize,compare,predict,infer
3.Applyexecutefamiliartask,,
applyproceduretounfamiliartask
4.AnalyzedisXnguish,focus,select,
integrate,coordinate
5.Evaluatecheck,monitor,detect
inconsistencies,judgeeffecXveness
6.Createhypothesize,plan,invent,
devise,design
Mostcomplextasks
Remembertomeasurefoods,drinks&readlabels.
35
WhataboutreadingnutriXonlabels?
• Howimportant?• Howcomplex?
Essen7al
Extremely
36
37
Information is better because it’s in chart form
Amount per serving
But, it contains a confusing technical symbol. Can you spot it?
“Amount/serving”
38
What’stheproblemhere?
39
And here?
Organic
Healthy No sugar
added 40
Pros: • Fewer items • Single vertical list • Major headings
stand out
Cons: • Lots of irrelevant
info
• Seemingly inconsistent info
Be=er,but…
41
FoodLabelrevision…counXngcarbohydrates
42
Bloom’staxonomyofeducaXonalobjecXves(cogniXvedomain)Simplesttasks1.Remember
recognize,recall,IdenXfy,retrieve
2. Understandparaphrase,summarize,
compare,predict,infer,
3.Applyexecutefamiliartask,,
applyproceduretounfamiliartask
4.AnalyzedisXnguish,focus,select,
integrate,coordinate
5.Evaluatecheck,monitor,detect
inconsistencies,judgeeffecXveness
6.Createhypothesize,plan,invent,
devise,design
Mostcomplextasks
Distractors: CHOs vs Fiber vs Fat
Carb vs non-carb ?? Sequence of label Total CHOs important, “Sugars” not Grams as volume vs wt
Part of meal vs snack OK? CHOs in intended serving? CHOs vs Fat/Chol vs Na
Location of relevant CHO (carb) gms
How many CHO gms in 1 serving? Subtract fiber gms from CHO gms
Plan a meal or snack
43
Ourefforts
1. Describejobofself-carefrompaXents’perspecXve
2. IdenXfythejob’smostcriXcaltasks
3. Trace(andlimit)cogniXvecomplexityoflearningtasks
4. Differen7ateinstruc7onbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. ProvidepaXenthandoutthatreinforceslearning
Howdifferentinabilitycanadultsbe?
44
Typicalliteracyitems,bydifficultylevelNaXonalAdultLiteracySurvey(NALS),1993
NALS difficulty level (& scores)
% US adults (age 65+)
peaking at this level
Simulated everyday tasks
5 (375-500)
3%
~0%
§ Use calculator to determine cost of carpet for a room § Use table of information to compare 2 credit cards
4 (325-375)
15% 4%
§ Use eligibility pamphlet to calculate SSI benefits § Explain difference between 2 types of employee benefits
3 (275-325)
31% 16%
§ Calculate miles per gallon from mileage record chart § Write brief letter explaining error on credit card bill
2 (225-275)
28% 33%
§ Determine difference in price between 2 show tickets § Locate intersection on street map
1 (0-225)
23% 47%
§ Total bank deposit entry § Locate expiration date on driver’s license
Daily self-maintenance in modern literate societies
45
NALS difficulty level (& scores)
% US adults (age 65+)
peaking at this level
Simulated everyday tasks National Adult Literacy Survey (NALS), 1993)
5 (375-500)
3%
~0%
§ Use calculator to determine cost of carpet for a room § Use table of information to compare 2 credit cards
4 (325-375)
15% 4%
§ Use eligibility pamphlet to calculate SSI benefits § Explain difference between 2 types of employee benefits
3 (275-325)
31% 16%
§ Calculate miles per gallon from mileage record chart § Write brief letter explaining error on credit card bill
2 (225-275)
28% 33%
§ Determine difference in price between 2 show tickets § Locate intersection on street map
1 (0-225)
23% 47%
§ Total bank deposit entry § Locate expiration date on driver’s license
§ level of inference (“connecting the dots”)
§ abstractness of info
§ distracting information
§ number of features to match
Not reading per se, but “problem solving”
Typicalliteracyitems,bydifficultylevelNaXonalAdultLiteracySurvey(NALS),1993
46
Complexity&aging
47
g-Basicinforma7onprocessing(GF)
BasicculturalKnowledge(GC)
Age-relatedcogniXvedecline
Learning&reasoningabilityAge8
48
Age80
Ourefforts
1. Describejobofself-carefrompaXents’perspecXve
2. IdenXfythejob’smostcriXcaltasks
3. Trace(andlimit)cogniXvecomplexityoflearningtasks
4. DifferenXateinstrucXonbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. ProvidepaXenthandoutthatreinforceslearning
49
“RxforPhysicalAc7vity”foraRuralCommunityHealthCenter
Linda S. Gottfredson, PhD School of Education University of Delaware Kathy Stroh, MS, RD, CDE Diabetes Prevention & Control Program Delaware Division of Public Health
Presented at the 2009 Diabetes Translation Conference of the Centers for Disease Control & Prevention (CDC). Long Beach, CA, April 24, 2009
50
51
52
Basicpedometer—justcountssteps
53
GraduatedRxBasic Rx
increases
speed
h=p://www.udel.edu/educ/gozredson/Rx54
55
Teachingtheteacher:ScriptforCDEwhenprescribing“RxforWalking”
Provides the CDE with:
Educationally sound teaching strategy • Key ideas • Content, sequence, and pace of
instruction, etc. Implicit training • Be concrete, personalize,
use meaningful metaphors, etc.
56
57
58
59
Lessonplan:Don’tassumetheyknowwhat’sobvioustoyou
Can’t assume: That patient will know:
• What a pedometer is • How to wear it • The exact regimen of the Rx
• i.e., extra steps
That the educator will know specific learning steps for: • Aim of script (e.g., extra steps) • How to adjust regimen
60
Ourefforts
1. Describejobofself-carefrompaXents’perspecXve
2. IdenXfythejob’smostcriXcaltasks
3. Trace(andlimit)cogniXvecomplexityoflearningtasks
4. DifferenXateinstrucXonbyability(“literacy”)level
5. Providescriptsforprovidersthatminimizecomplexity
6. Providepa7enthandoutthatreinforceslearning
61
62
Thankyou.
QuesXons?Advice?
63
64
5levelsofdiabeteseducators*o Level1,non-healthcareprofessional,o Level2,healthcareprofessionalnon-diabeteseducator,o Level3,non-credenXaleddiabeteseducator,
v Level4,credenXaleddiabeteseducator,andv Level5,advancedleveldiabeteseducator/clinicalmanager.
*AmericanAssociaXonofDiabetesEducators(AADE)(2011).ScopeofPrac*ce,StandardsofPrac*ce,andStandardsofProfessionalPerformanceforDiabetesEducators,p.4.h=p://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/ScopeStandards_Final2_1_11.pdf 65