Education for Life-Long Conditions Flashcards
what things get in the way of behaviour?
emotional well-being
motivation
importance
health beliefs
experiences
most people ____ what they ______ __ but it doesnt always change their _______
most people know what they should do but it doesnt always change their behaviour
does education alone change behaviour?
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
knowledge doesnt necessarily mean behaviour, what is inbetween?
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
what is insanity?
doing the same thing over and over again and expecting different results
what is living with diabetes like?
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
What are the national targets for glycemic control?
Type 1 diabetes - 6.5% (48 mmol/l)
How achievable is the national targets for glycaemic contorol?
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?
there are also current _________ challenges
technology
Whole Clinic HbA1c - Grampian:
Describe what is seen here
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
What are the levels of adolescents’ HbA1c like?
Similar for adolescents
50th percentile is 9.45
What is HADS?
Hospital Anxiety and Depression Scale
Describe the levels of secondary care HADS screening?
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%
what are things that may affect a patients psychological wellbeing?
- 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)
As soon as you add in ______ to diabetes the job gets a lot harder
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
what things can depression cause?
rumination (deep or considered thought about something)
fatigue
< socialising
sadness
< motivation
< enjoyable activities etc
what may bepression be linked to?
may or may not relate to diabetes
How much people that have diabetes have depresison?
Incidence rate of ~20% (5% in general public) - prevalence ~ same in types 1, 2 kids & adults
Do peole with depression often seek treatment?
Generally people reluctant to seek treatment
is relapse of depression common?
Relapse more common than not (50% in 2 years; 75% in 5 years) + 10-20% stay depressed
People with higher __________ scores tent to have higher _____
depression
HbA1c
what does anxiety & diabetes cause?
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
What factors affects the ability of people with LTCs to engage in healthy behaviours?
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?
Seriousness of condition
Effectiveness of treatments
Costs & benefits of following advice
Self-efficacy
Vulnerability to future problems
Impact of illness
why do we behave as we do?
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
Is there jsut one reaosn for carrying out a particular behaviour?
Different reasons for each person engaging in the same behavior
what does the function of behaviour allow us to understand?
It is the function of behaviour that helps us understand patients not behaviour per se
what makes up functional analysis?
ABC
Antecedents, Behaviour, Consequences
This is a key method of formulation and relies on accurate identification of “problem” behaviours
Balancing Shorter- & Longer-Term Gains:
what may the avoidance of uncomfotable thoughts and feelings lead to?
2 examples showing how the function of behaviour can be different:
what is reinforcement?
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
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
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
Functional Analysis: ABC not taking insulin after work
what can you do?
- Highlight behaviour
- look at emotional distress
- Prompts (text alert)
- Importance (?education)
- Confidence levels… (?self-esteem)
How can we break well established habits?
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)
behaviour cahnge can…….
- prevent disease
- improve disease management
- improve quality of life
Behaviour (change) is good for your health!
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
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
