Background on Individual Education
What are individual education strategies?
- Strategies that work to prevent and manage diabetes by increasing knowledge and improving problem solving skills regarding diabetes related issues such as glucose management, nutrition, physical activity, and eye and foot care.
- Previous studies have shown it is important to provide information about diabetes as well as increase skills to improve an individual’s confidence in their ability manage diabetes.
- Individual education interventions should be culturally sensitive, involve family and friends, and incorporate the individual’s readiness to change behavior, as appropriate. Most individual education interventions provide information to individuals, with some offering individuals opportunities to ask questions or get clarification (e.g., through a face to face session with a health educator).
How can individual education impact diabetes related behaviors?
- Your intervention may focus specifically on increasing people’s awareness of the importance of paying attention to diabetes risk factors and symptoms, monitoring glucose levels, adhering to medication schedules, quitting smoking, and improving nutrition (e.g., reduce caloric intake, decrease fats and sugars, increase fiber) and physical activity (e.g., walk at least five days a week for at least 30 minutes a day).
- Specific activities may include skill-building opportunities (e.g., self-management of glucose and medication), obtaining support (e.g., change family eating patterns, get a walking partner), identifying barriers to behavior change (e.g., worrying about glucose levels, inability to eat what the individual wants), helping people to develop strategies to overcome barriers, and preventing the urge to go back to previous behaviors once they have changed (relapse prevention).
How can I use individual education strategies in asthma interventions?
- The specific strategies used differ based on the focus of the intervention. For example, information may be provided through directly through individual counseling sessions or self-help materials such as newsletters, brochures, posters, fact sheets, videos, automated voice messaging, computer video games, or interactive computer programs. Other strategies may provide cues to action rather than specifically increasing knowledge (e.g., worksheets prompting individuals to enter their blood glucose levels). The content of the message may focus on a wide variety of materials, including: information (e.g., energy requirement calculations, blood glucose monitoring), recommendations (e.g., medication schedule, meal planning), resources (e.g., referrals to health education classes or support groups), or skill-building exercises (e.g., glucose injections, physical activity).
How do “tailored messages” and “targeted messages” differ? How can I use these messages in diabetes interventions?
- Individual education interventions may be developed specifically to match the individual. “Tailored messages” take into account specific individual characteristics in creating diabetes messages. Materials or strategies may be developed to meet an individual’s characteristics in terms of readiness to change, attitudes, beliefs, behaviors, and other lifestyle characteristics. The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them prevent or manage diabetes depending on how ready they are to change their behaviors.
- Tailored health education materials are developed based on characteristics that are unique to each individual; therefore, an individual assessment (e.g., survey, interview) is required in order to collect information specific to the individual. For example, a recommendation to change eating patterns may take into account the following information about the individual:
- Alternately, other materials or strategies may be geared toward a specific subgroup of the population of interest (e.g., children and pregnant women). These are often called “targeted messages” because they consider the specific needs of this subpopulation. In a similar manner, these strategies can be used to influence groups of people (e.g.,increase activity levels in children, discuss dietary restrictions for pregnant women), but the messages are not specific to each individual.
What is an example of a tailored message?
- Harry, a fifty-year old automotive worker who has recently been diagnosed with diabetes has thought about increasing his physical activity because he knows it will help him stay healthy. Yet, he is always physically tired, so it is difficult for him to get motivated to be active. At work, he rides a cart instead of walking down the factory floor, and, when he gets home, he doesn’t feel like exercising. He has thought about walking at lunch, but there is no place around his work to walk and he doesn’t have the flexibility to leave work to exercise. He is also really worried about gaining weight. Other people with diabetes have told him that being physically active can help to prevent or reduce the negative complications associated with the disease. While Harry knows that in the long run being physically active can improve his health, he doesn’t really see that as a significant issue to worry about at the moment. He feels fine. In this case, a message can be designed for Harry as follows:
- “Harry, being more physically active now can help increase your energy and keep you feeling your best. The first step is to think about incorporating more physical activity into your daily routine. There are easy ways to increase your activity. Consider walking to and from different places at work instead of using carts or elevators or park in the back of the parking lot. Get small amounts of physical activity to help you keep your diabetes under control and reduce your risk for the negative health complications. You can start today. Keep reading to find out some specific tips you might find helpful in thinking through how to be more physically active at home and work in order to increase your energy!”
What is skill building and how can I use it in diabetes management interventions?
- Skill building increases an individuals capacity and skills to change behavior through self-management.
- Self-management takes individuals through a process of identifying an issue (e.g., high levels of glucose), assessing their routine through self monitoring (e.g., keeping track of glucose levels with respect to meals, snacks, and activities), making sense of their routine (e.g., what is happening that increases or decreases glucose levels?), identifying and setting a goal, contracting a change, developing an action plan to achieve the goal (e.g., including how to overcome barriers), developing specific skills to overcome these barriers and achieve the goal (e.g., developing ways to incorporate glucose monitoring into daily routine), and rewarding changes as they are made.
- Skill building strategies can be tailored to individuals or targeted to the population of interest, such as taking medications or recipe development or alteration. Both tailored and targeted strategies can be delivered at one time or at regular intervals (e.g., weekly, monthly or quarterly). The intervention information can appear in the form of print, telephone, video or computer kiosk messages. Incentives may be used to raise awareness, encourage participation, increase motivation, and reward success.
How can previous research and experience shape future diabetes education interventions?
- Previous work suggests that self-management interventions may be more effective with regular reinforcement than one-time or short-term education.
- Different individuals and groups may have different perspectives on their role in managing their illness. This may influence their interest in and ability to engage in self-management practices.
- Self-management is also affected by the individual’s access to healthy food options, places to be physically active, or medical care and medical supplies (e.g., glucose testing materials). Likewise, self-management is also influenced by the media and broader social and cultural norms in the community (e.g., perceptions of overweight and obesity, trust in health care providers).
Can individual education interventions utilize web-based settings?
- Some studies describe advantages of an interactive, web-based tailored intervention over a more traditional print version, including: the ability to receive immediate feedback, an interactive nature similar to interpersonal counseling, and the ability to use graphics and other features to increase interest and attention.
- Once on the web, the tailored intervention can reach a relatively larger group of people making it more cost-effective. In addition, it can be updated continuously to include the most recent knowledge of risk factors and health conditions related to diabetes.