Supporting the process of personal change in diabetes self-management during group education: Lessons learned from audio recorded sessions

Abstract

Objective: The objective of this paper is to describe the education process during a pilot group education program for people with type 2 diabetes in Belgium. The specific aims were to explore the personal change processes during the group sessions and to identify supporting and hindering elements in/for these processes.

Methods: We used a qualitative research approach from a constructivist perspective to study the education process during the group sessions. Two theoretical frames (trans-theoretical model and Strengths-Weaknesses-Opportunities-Threats (SWOT)-matrix) were used to document changes in (motivation towards) self-management and to explore how the program influenced this change process.

Results: Supporting elements for personal change were identified and comprise: an empowerment attitude and tailored approach focusing on expectations and needs, the goal-setting process (mainly objectivizing current behaviour), peer support and using social support networks and community activities. Hindering elements include: providing extensive and detailed information not related to individual goals, the optional nature of the program in relation to active participation, too much focus on the expert role of the coaches and contextual barriers like an unsupportive environment/GP and co morbidity.

Conclusions: Based on the audio-recordings of the group sessions, we can conclude that many people did change their self management behaviour (or started reflecting on it) while following the program. We were able to document concrete changes people made but we could only identify a few links between specific program components and specific changes processes (e.g. pedometer, nutritional information). However, the SWOT analysis provided interesting knowledge that can inform future programs and support educators during group sessions. First, a flexible approach may be preferable to stage-specific approaches. In addition, the analysis drew attention to the fact that not everybody needs to change behaviour. What a program should aim for, is that everyone starts reflecting and subsequently takes an informed decision to change or not. Finally, diabetes educators should find a balance between their three different roles (expert, coach, and moderator) and should be provided with professional support.