According to a researcher, people with type 2 diabetes and other chronic diseases should be more actively involved in the group-based programmes offered by the healthcare system. Healthcare professionals favour a more person-centred approach, but this turns out to be difficult to implement in practice.
People diagnosed with type 2 diabetes face major challenges: they must learn how to navigate in a complex everyday reality with diabetes while maintaining a high quality of life. Thus, it is a demanding process that requires support, guidance and education. This is widely offered through group-based education facilitated by healthcare professionals such as nurses, dietitians and physiotherapists.
However, healthcare professionals facilitating group-based diabetes education frequently face challenges. They must translate the professional knowledge they have about diabetes into useful knowledge targeting the people in the group sessions. This can be challenging for healthcare professionals who have not acquired these skills in their formal education.
“Many healthcare professionals are challenged in the transition from an expert-led role towards a relationship-building role focusing more on collaborating with people with diabetes. We therefore need to focus on systematic training, helping each professional in mastering professional skills that do not come naturally to them and using the various roles interchangeably during group education,” explains Vibeke Stenov, postdoctoral fellow and researcher in psychosocial methods in diabetes care at Diabetes Management Research, Steno Diabetes Center Copenhagen.
One thing she has investigated is how to optimally equip health professionals to address the needs and challenges individual people with diabetes face in a group-based, person-centred educational approach.
“We see a transition in Denmark’s healthcare system towards making more use of these methods. Healthcare professionals have plenty of goodwill, but this turns out to be difficult to implement in practice. Being a good group facilitator who also focuses on individuals’ preferences and needs requires a diverse set of professional skills that healthcare professionals do not necessarily develop in their basic education,” says Vibeke Stenov.
Requires new competencies and support from management
According to Vibeke Stenov, the group-based, person-centred approach requires that healthcare professionals develop and learn new skills. They must change their practice from a classic expert role – teach and tell – towards a collaborative and dialogue-based approach that actively integrates the participants’ experiences, concerns and needs into the educational content. Not all healthcare professionals can easily apply this approach, since it requires training and development of professional skills.
Vibeke Stenov therefore investigated how group-based, person-centred methods targeting people with diabetes can optimally be implemented among healthcare professionals – and what pitfalls may arise.
She concludes that attention and systematic training are necessary to create a successful transition to a genuinely person-centred approach in group sessions among people with diabetes. This requires time and resources that are often lacking in the Danish healthcare system.
“We need to devote time and resources to train healthcare professionals in person-centred approaches so that they can confidently use them. However, this can be a challenge for busy professionals and therefore requires support from management,” says Vibeke Stenov.
Identifying strengths and focus areas
This research is based on three studies involving both group participants with type 2 diabetes and healthcare professionals. The first study involved 49 group participants and 13 healthcare professionals and investigated approaches that supported or hindered person-centredness in groups. The observations were supplemented with interviews with healthcare professionals.
The second study comprised two research workshops in which 14 healthcare professionals across five settings in the Capital Region of Denmark participated in developing new ways of working with the person-centred approach in groups.
The third study tested the new approaches identified in the first two studies in a pilot project. The analysis of the pilot project led to a third workshop, in which the new approaches were redesigned based on the pilot project.
“We need to find a way to identify the necessary professional skills. One method to enable this is the health education juggler: a model comprising four professional roles required to effectively facilitate group-based, person-centred education. This model has been further developed into a concrete method that can be used for developing professional skills by enabling health professionals to identify which skills they want to focus on during the process,” explains Vibeke Stenov.
The four educator roles are: embracer, facilitator, translator and initiator. Juggling is a metaphor for the situation of the professional, who must simultaneously manage, master and switch between roles during a group session. Vibeke Stenov has developed various dialogue tools to support healthcare professionals in facilitating group-based, person-centred education
Implications for several parts of the healthcare system
Individual meetings between people with chronic illnesses and healthcare professionals are increasingly being replaced by group sessions, particularly in the treatment of people with diabetes, but also for people with other chronic diseases such as chronic obstructive pulmonary disease, arthritis and cardiovascular diseases. The common denominator of all these diseases is that people must learn to manage their disease in the complex context of their daily life.
According to Vibeke Stenov, gathering people with chronic illnesses into disease-specific groups has many advantages, since they can benefit greatly from being together. However, this requires equipping the healthcare professionals, who lead the groups, for the task. Her research may therefore influence the approach to group-based patient counselling and education in several parts of the healthcare system.
“Many people with diabetes and other chronic diseases need to be educated and supported to manage a disease that often requires lifestyle changes and many complex adjustments. Sharing experiences among peers in group-based programmes can be supported if healthcare professionals purposefully strive to actively incorporate experiences, concerns and needs into the content,” concludes Vibeke Stenov.
“Group-based, person-centered diabetes self-management education: healthcare professionals’ implementation of new approaches” has been published in BMC Health Services Research. Vibeke Stenov is a postdoctoral fellow in Diabetes Management Research at Steno Diabetes Center Copenhagen. Earlier this year, the Novo Nordisk Foundation awarded her a fellowship for research on a special stress condition that people with diabetes can develop under the project Development and Testing of a Group Intervention Facilitated by Nurses to Reduce Diabetes Stress among Adults with Type 1 Diabetes.
