Translating Psychosocial and Behavioral Findings Into Practice

Thursday, August 11, 2005

Breakout Session

Speaker
Leonard Jack, PhD, MSc

Reported by Joelle Escoffery, PhD

As the burden of diabetes continues to increase, strategies to treat not only the physiologic aspects of the disease but also its psychosocial aspects will take on increasing importance. There are a variety of factors that contribute to the rising incidence of diabetes and obesity, including demographics, environmental factors, behavioral and psychosocial factors, institutional factors, community factors, and policy factors. Accordingly, research in the area of diabetes self management must focus not only on patient variables, but also on their social and environmental context. Education is necessary but not sufficient for optimal diabetes self management.

One problem that has plagued the area of psychosocial diabetes research is the lack of standardization. No consistent definition of the overall concept or individual psychosocial variables has been given. For the purposes of this presentation, psychosocial factors were defined as a collection of important psychological, emotional, and social determinants that are influenced by personal and environmental factors. A review of the literature showed that self-efficacy, health beliefs, and coping were the most frequently studied psychosocial variables, with issues such as stress, anxiety, depression, fear, motivation, and locus of control also receiving some attention. Of these factors, self-efficacy has been the most highly predictive of short-term behavioral outcomes. The social component (eg, family relations, social support, support from friends, relationships with healthcare providers) has focused primarily of children with type 1 diabetes. Little work has been done to assess the importance of social interaction in type 2 diabetes.

A review of available literature demonstrated a number of important points. First, a majority of research in this area has been correlational rather than interventional. Few efficacy studies and no effectiveness studies have been conducted. Further, there was very little standardization in terms of how psychosocial variables were operationalized for research purposes. There was a also noticeable lack of overarching theory in a majority of the work.

In spite of these limitations, several strategies for patient education were suggested, including:

1. Frame the teaching to match patient perceptions
2. Fully inform patients of the purpose of a treatment or intervention, as well as its intended effects
3. Recommend small, rather than large changes
4. Be very specific in making recommendations
5. It is easier to add a new behavior than to remove an existing one
6. Link new behaviors to old ones
7. Get explicit commitment from patients
8. Use a combination of strategies to increase success
9. Use a multifaceted team, if available
10. Refer patients for mental health services when necessary
11. Address and promote self efficacy

Because a majority of diabetes care takes place in the real world, it is important not only to educate patients, but also to address their psychosocial concerns to increase the likelihood of successful patient self management.