Background on Supportive Relationships
What are supportive relationship strategies?
- Supportive relationships interventions are programs or activities designed to increase social support to prevent and manage diabetes through involvement with individuals, organizations and communities.
- These interventions may focus on increasing the information individuals have about diabetes and diabetes care [informational support], provide a venue for sharing experiences and feelings [emotional and appraisal support], or provide tangible assistance (e.g., assistance with glucose testing). In addition, such interventions provide opportunities to identify and address challenges collectively rather than individually.
- This support may be provided through involvement from a variety of individuals or individuals as part of groups, organizations, or communities including:
- school nurses
- community health advisors
- Supportive relationships interventions may help to reduce the risk of developing diabetes (primary prevention) or work with those who have already developed diabetes in order to decrease the negative complications of diabetes through lifestyle behavior change and self monitoring of glucose levels (secondary prevention).
How do supportive relationships impact diabetes related behaviors?
- Supportive relationship interventions are successful for many reasons: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual, and longer-term relationships can help to sustain behavior change over time, among others.
How can I use supportive relationship strategies in a diabetes intervention?
- Supportive relationships interventions may be designed to include a discussion of challenges, benefits, and advice for diabetes self-management. Supportive Relationships may be provided in the form of face-to-face interactions, telephone calls, or through interactive web-based systems. These interventions may include specific information as part of each call or face-to-face session, or may be more open-ended and responsive to the specific needs of the individual.
Why is it important to considering tailoring in supportive relationship strategies?
- These interventions can be very successful when the support is tailored to the individual’s needs. For example, if the individual is having difficulty being physical active the support can be around how to manage diabetes through physical activity.
- In order to provide tailored advice to the individual, the person providing the support has to determine the specific diabetes management challenges the individual is facing. An assessment of the individual’s health behaviors, glucose level, and readiness to change may be necessary.
- Supportive relationship interventions work best when the advice also takes into account the person’s gender, age, language, race or ethnicity, and other cultural factors.
What is “readiness to change” and how does it relate to supportive relationships?
- 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 their diabetes depending on how ready they are to change their behaviors. Supportive relationships may be particularly important when people are ready to change their self-management behaviors (i.e., supportive relationships can help to reinforce these decisions.
How do supportive relationship strategies deal with relapse?
- Because diabetes is a chronic disease, many individuals may initiate behavior changes (e.g., minimize consumption of foods with sugar and fat, get regular physical activity) and then relapse or go back to less healthy lifestyle choices. Support often includes information to help individuals to recognize that this is not unusual and to work with individuals to develop strategies to help prevent relapse in the future (see Relapse Prevention Theory).
- It can be helpful to recognize that changes in diabetes prevention and management behavioral patterns may happen in small steps. For example, adding fruit and vegetables may be the first step, followed by reducing the fat in commonly used recipes (e.g., skim milk instead of whole milk, canola oil rather than vegetable oil), reducing sugar in snacking habits (e.g., carrot sticks instead of candy), or decreasing portion sizes (i.e., choosing small soda instead of a large soda). Every individual will have preferences for what steps make be the easiest to take first, and these preferences may depend to a large extent on the support of others for these changes (e.g., family, roommate, friends, co-workers).
How have supportive relationships been used in past diabetes interventions?
- Increase health care provider support for diabetes prevention and management. For example, a health care provider may provide support to an adult with diabetes to increase his or her compliance with diabetes medications or a school nurse can provide support to teenager to monitor his or her glucose levels. Health care provider support may be offered through face-to-face interactions, letters, or telephone calls. These support efforts may be initiated by the health care provider or the patient or client (e.g., counseling during an office visit, telephone numbers the individual can call for support when needed, websites the individual can access to ask questions or share concerns).
- Increase school-based support for diabetes prevention and management. For example, peer educators can be trained to provide support through school-based activities such as athletic programs; teachers, school nurses, and coaches can be trained to provide formal structured support (e.g., individual tutoring sessions covering diabetes related topics) or less formal support (e.g., advice or encouragement); and family members can be encouraged to provide support through joint educational and skill building sessions, letters, newsletters, or videos sent home with the students. These cues to action (see Health Belief Model) can describe or illustrate the challenges of diabetes management (e.g., showing peer models making decisions not to eat certain foods at school functions) and instigate discussion between school representatives, family members, and students about these struggles.
- Increase worksite support for diabetes prevention and management. For example, worksites can be considered a mini-community with interventions that provide tangible support (e.g., employee input into what foods and drinks are available in the cafeteria and vending machines), informational support (e.g., contact information for individuals responsible for maintaining organizational resources and information), and emotional and appraisal support (e.g., buddy systems, lay health advisors, or team contests). Some worksite supportive relationships interventions have been initiated by management while others have been developed jointly through labor and management negotiations.
- Increase support from faith-based organizations for diabetes prevention and management. Faith-based organizations may, for example, help people recognize that health is part of the divine message through connections between the spiritual and physical being. Specific activities or messages can help individuals to prevent or manage their diabetes (e.g., nutritious foods served at social gatherings, walking clubs organized through faith-based organizations). Through health ministry and membership in the faith community, these organizations can also increase knowledge and skills about the health risks or benefits of preventing and managing diabetes through health messages as part of sermons or testimonials from congregation members. Ministers, faith community nurses (e.g., parish nurses), and members have prayed with fellow members, found resources for them, comforted them, and helped to nurture them. Faith-based organizations are an ideal setting because people look to them for social support and interaction. Faith-based organizations can incorporate diabetes prevention and management as part of their mission and serve as centers of daily life, social structure, and community life.
- Increase community support for diabetes prevention and management. For example, informational, emotional, and appraisal support can be provided through websites, phone calls, or automated messages (e.g., program initiated calls to individuals, predetermined messages on certain topics being made available when people call a certain number). Individuals staffing these lines may be medical personnel, health educators, or trained lay health advisors. Other examples of community support include the use of community role models who can speak to community members about the risks of diabetes (i.e., Olympic champions, sports players, and other local celebrities who have diabetes).