Education for Life-Long Conditions

Question 1

what things get in the way of behaviour?

Answer 1

emotional well-being

motivation

importance

health beliefs

experiences

Question 2

most people ____ what they ______ __ but it doesnt always change their _______

Answer 2

most people know what they should do but it doesnt always change their behaviour

Question 3

does education alone change behaviour?

Answer 3

There is hardly any evidence that ‘education’ alone can change behaviour

Have to support people through the process and help people find their own solutions to problems.

Knowledge – intention- change

Question 4

knowledge doesnt necessarily mean behaviour, what is inbetween?

Answer 4

In between is intention which is effected by a huge range of things that we spoke about

Gap between knowledge and behavior which is often overlooked

Intention is what helps our patients make changes to their self management in the long term

Question 5

what is insanity?

Answer 5

doing the same thing over and over again and expecting different results

Question 6

what is living with diabetes like?

Answer 6

Diabetes is a complex disease

Controlling and managing diabetes can be a challenge for anybody living with the condition

Adjustment to diagnosis can be difficult as well as burnout

Diabetes is like a full time job where you get no holiday

Diabetes can be a difficult task to juggle

Everyone is different

Question 7

What are the national targets for glycemic control?

Answer 7

Type 1 diabetes - 6.5% (48 mmol/l)

Question 8

How achievable is the national targets for glycaemic contorol?

Answer 8

Setting realistic goals

similar to telling a kid at primary school to get 95% in every test that they do – impossible task

are we setting patients up to fail?

Question 9

there are also current _________ challenges

Answer 9

technology

Question 10

Whole Clinic HbA1c - Grampian:

Describe what is seen here

Answer 10

National guidelines sit at 6.5/ 48mol/L

We collected data in Grampian – a few years ago now

However you can see the distribution here – how many people actually achieve this target – 6th percentile which means more than 94% do not meet this target

As soon as we add anything to the mix including stress, which is very common – our targets seem bit redundant

6.5 is the target so Grampian levels not great

Question 11

What are the levels of adolescents’ HbA1c like?

Answer 11

Similar for adolescents

50th percentile is 9.45

Question 12

What is HADS?

Answer 12

Hospital Anxiety and Depression Scale

Question 13

Describe the levels of secondary care HADS screening?

Answer 13

Here are the results of the screening

As you can see – anxiety and depression is very common in this population

~18% have clinical level problems

Include borderline: Anxiety = 30%; Depression = 20%

Question 14

what are things that may affect a patients psychological wellbeing?

Answer 14

• Anxiety & Stress
• Depression & Low Mood
• Adjustment problems
• Eating-related & body image difficulties

(People often have another problem along side their diabetes such as the ones listed and this is common and they may self refer their self’s)

Question 15

As soon as you add in ______ to diabetes the job gets a lot harder

Answer 15

stress

Stress makes blood glucose levels rise

Cortisol kicks in – function of fight or flight system – trying to raise energy for the body to survive and get away

Question 16

what things can depression cause?

Answer 16

rumination (deep or considered thought about something)

fatigue

< socialising

sadness

< motivation

< enjoyable activities etc

Question 17

what may bepression be linked to?

Answer 17

may or may not relate to diabetes

Question 18

How much people that have diabetes have depresison?

Answer 18

Incidence rate of ~20% (5% in general public) - prevalence ~ same in types 1, 2 kids & adults

Question 19

Do peole with depression often seek treatment?

Answer 19

Generally people reluctant to seek treatment

Question 20

is relapse of depression common?

Answer 20

Relapse more common than not (50% in 2 years; 75% in 5 years) + 10-20% stay depressed

Question 21

People with higher __________ scores tent to have higher _____

Answer 21

depression

HbA1c

Question 22

what does anxiety & diabetes cause?

Answer 22

Worry

nausea

< focus

restlessness

shaking

muscular tension

sweating

avoidance

Symptom overlap problem often very important leads to inappropriate self-care behaviours

may or may not relate to diabetes

may have a fear of hypo so intentionally raise BG

Question 23

What factors affects the ability of people with LTCs to engage in healthy behaviours?

Answer 23

Question 24

Often health beliefs are not the same as the patient

May be hard to get them to change their behaviour

what are some percieved health beliefs?

Answer 24

Seriousness of condition

Effectiveness of treatments

Costs & benefits of following advice

Self-efficacy

Vulnerability to future problems

Impact of illness

Question 25

why do we behave as we do?

Answer 25

Behaviour doesn’t happen in a vacuum

Understanding why we do what we do helps us change behaviour

We are generally trying to be happy/and or avoid pain

The function of behaviour is idiosyncratic – people do the same thing for different reasons

All behaviors happen within a context

Behavior has multiple causes or sources of influence

Question 26

Is there jsut one reaosn for carrying out a particular behaviour?

Answer 26

Different reasons for each person engaging in the same behavior

Question 27

what does the function of behaviour allow us to understand?

Answer 27

It is the function of behaviour that helps us understand patients not behaviour per se

Question 28

what makes up functional analysis?

Answer 28

ABC
Antecedents, Behaviour, Consequences

This is a key method of formulation and relies on accurate identification of “problem” behaviours

Question 29

Balancing Shorter- & Longer-Term Gains:

what may the avoidance of uncomfotable thoughts and feelings lead to?

Answer 29

Question 30

2 examples showing how the function of behaviour can be different:

Answer 30

Question 31

what is reinforcement?

Answer 31

Reinforcement can be tangible; social, or any aspect of internal events

Any behavior will either be rewarded or punished

Look at behavior and think how likely it is to happen again and what is its function

Question 32

Actions drive __________

Consequences that are reinforcing make behaviour more likely to _____ ______

Consequences that are __________ are unlikely to happen again

Knowing about the ______ of a health related behaviour (or non-behaviour) helps us understand what maintains it

Answer 32

Actions drive consequences

Consequences that are reinforcing make behaviour more likely to occur again

Consequences that are unpleasant are unlikely to happen again

Knowing about the function of a health related behaviour (or non-behaviour) helps us understand what maintains it

Question 33

Functional Analysis: ABC not taking insulin after work

what can you do?

Answer 33

• Highlight behaviour
• look at emotional distress
• Prompts (text alert)
• Importance (?education)
• Confidence levels… (?self-esteem)

Question 34

How can we break well established habits?

Answer 34

Stress reducing techniques - Online self-help/psychology/mindfulness

Involve key people in behaviour change - Friends; family; HCP

Use prompts – apps, alerts on phone

Importance (0-10) if important will be motivated to change; if not important then unlikely to change

Confidence in changing (0-10)

Question 35

behaviour cahnge can…….

Answer 35

• prevent disease
• improve disease management
• improve quality of life

Behaviour (change) is good for your health!

Question 36

Summary:

• Many factors influence self-management/health __________
• People behave in the same way for different reasons - ___________ is idosyncratic
• Emotional __________ can influence behaviour
• We need to establish what drives a __________ before negotiating a way forward
• ____ _______ is a key skill in behaviour change
• Consider a persons ________ and what is important to them in life

Answer 36

Summary:

• Many factors influence self-management/health behaviour
• People behave in the same way for different reasons - behaviour is idosyncratic
• Emotional difficulties can influence behaviour
• We need to establish what drives a behaviour before negotiating a way forward
• Goal setting is a key skill in behaviour change
• Consider a persons values and what is important to them in life