PSYCHO-SOCIAL ASPECTS OF
DIABETES MANAGEMENT
Barbara Dale L.C.S.W. Clinical Director,
Visiting Nurse Health System, Long Term Care at Home
and
Karen Watkins, PhD., L.M.S.W.
Clinical Assistant Professor, School of Social Work Georgia State
University
Overview


Psychosocial Factors
Review of Evidenced-Based Diabetes
Self-Management Interventions/Programs (DSME)
 Case

Management
 Community
Motivational Interviewing
Motivational Interviewing Techniques

Community Resources

Psychosocial Factors of Older Adults with
Diabetes

Depression Symptoms

Cognitive Decline

Low Social Support

Major Stressful Life Experiences

Living in Urban versus Rural Environments

Cultural implications

Economic Resources

Stress and anxiety

Educational/ literacy levels
Protoplasmix.wordpress.com
(Bertera, 2006; DeCoster, 2001, 2009; Funnell et.al. 2007; Hewitt et.al 2010; Ling & Boey 2000; Lustman, 2000;
Lustman & Clouse, 2004; Lustman et. al., 2000; Trief et.al, 2006; Schillinger et.al 2002 etc.)
Evidenced Based
Self-Management Interventions
Community

Social Support
Case Management

Community Health Worker

Home Health
Networks

Adult Day Care

Diabetes Club

Mental Health

Focus Groups

Videophone

Psychoeducational

Telephonic
Groups
Community Interventions

Social Support Networks

Adult Day Care

Diabetes Club

Focus Groups

Psychoeducational
Health.com
(Bertera, 2003; Cheng & Boey, 2000; Dabelko & DeCoster, 2007; DeCoster & George 2005; Lisbeth et. al.,
2011; Trozzolino, et.al., 2003)
Case Management Intervention

Community Health Worker

Chronic Disease
http://patienteducation.stanford.edu/programs/diabeteseng.html
Casemanagementstlouis.com

Home Health

Mental Health

Videophone

Telephonic
(Garrelts et.al. 2010; Hawkins, 2010; Lee, 2004; Leeman et.al. 2008; Skelly, 2010; Spencer et.al 2008)
MOTIVATIONAL
INTERVIEWING
Evidenced-Based Approach to Behavior Change
Motivational Interviewing
“… a collaborative, person-centered form of
guiding to elicit and strengthen motivation for
change.”
 Developed
by William Miller 1983
 www.motivationalinterview.org



Motivational Interviewing and Healthcare
Motivational Interviewing and Older Adults
Motivational Interviewing and Diabetics
(Chen et.al, 2012; Cummings et.al., 2009; El-Mallakah et.al, 2012; Hunt, 2011; Miller & Rollnick, 2002; Minet
et. al 2011; Ridge et. al. 2012; Rubak, 2009; Welch et. al. 2006; Welch et.al. 2010)
No Time for Listening

Brief, Practical Medical Interventions

Effective discussion on front end can reduce
headache on back end

Increase success with “non-compliant” patients

Increase levels of “change talk” and decrease
resistance to change

Well-intended suggestions fall on deaf ears
The Visit
http://www.youtube.com/watch?v=80XyNE89eCs
http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html
Based on her conversation with the
MD, is she likely to stop smoking ?


1___2___3___4__5___6___7__8__9__10___
1= not at all
10= absolutely
Stages of Behavior Change






Precontemplation
 ”I don’t have a problem”
Contemplation
 “I know I should change”
Preparation
 “I’m taking steps to do something soon”
Action
 I’m doing it!!”
Maintenance
 “I’ve been doing it for at least 6 months!”
Relapse
 ”OOPS!”
Stages of Behavior Change
http://well-fitbodies.com/yahoo_site_admin/assets/images/Stages_of_Change.23130956_std.JPG
MI Techniques

Ask permission to discuss issue “You’ve been
having these worrisome lab results, can we discuss
this ?”

Reflective listening Say back what you hear them
saying; focus on ambivalence

Ask open-ended questions “What might your life
look like without this change?”
wrmtraining.com

Elicit a response “What do you know about..”

Give affirmation “This is really hard” (use scale)

Summary of conversation and interventions
Scale of Change



Assess “Readiness”, “Confidence” and,
“Importance” of change by using scale
1___2___3___4__5___6___7__8__9__10___
1= not at all
10= absolutely
MI Techniques in Action
Motivational Interviewing-Evoking a Commitment to Change
http://www.youtube.com/watch?v=dm-rJJPCuTE
http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html
GUIDE/INSTRUCTOR/LISTENER

The Guide- asking open ended questions
to raise doubt and help patients make
informed decisions(“What might your
life look like if you don’t make these
changes?”)

The Instructor- being more directive
when the time is right

The Listener- gathering information
about the patient’s situation; focusing on
their ambivalence
socialmediagovernance.com
DARES Principles

Develop Discrepancy-patient should present arguments
for change

Avoid Argumentation-back off if too much resistance

Roll with resistance- try to understand where they are

Express empathy- reflective listening

Support self-efficacy- support ability to change and
coming from (“I hate these meds”; “It hurts giving
myself shots”)
build confidence
Miller WR, Rollnick S. Motivational Interviewing, Second Edition: Preparing People for Change. New York: Guilford Press; 2002.
Effective Physician Video
http://www.youtube.com/watch?v=URiKA7CKtfc
http://www.healthteamworks.org/guidelines/MotivationalInterviewing.html
Community Resources
National

American Association of Diabetes Educators www.diabeteseducators.org

American Diabetes Association- www.diabetes.org

Area Agency on Aging – National Website www.aaaphx.org/

National Center for Chronic Disease Prevention and Health Promotion –
www.cdc.gov/nccdphp

National Diabetes Educational Program- www.ndep.nih.gov

National Institute on Diabetes and Digestive and Kidney Diseaseswww.niddk.nih.gov
State

Area on Aginghttp://www.georgiaservicesforseniors.org/Default.aspx#OutputAnchor

Atlanta Regional Commission Age Wise - www.agewiseconnection.com

Community Care Services Program (CCSP) 404-463-3333

GA Area Agencies on Aging- http://www.georgiaservicesforseniors.org/

Service Options Using Resources and Community Environments (SOURCE)
(404) 463-3248 www.payingforseniorcare.com/
http://www.georgiaservicesforseniors.org/
Community Resources cont.
Local
Atlanta Medical Hospital- (404)265-4000 www.atlantamedicalcenter.com/

DeKalb Medical Center- (404) 501-1000 www.dekalbmedical.org






Diabetes Association of Atlanta (Multiple Support Programs) www.diabetesatlanta.org
Emory Healthcare System- (404) 778-7777 www.emoryhealthcare.org/
Grady Diabetes Clinic- Main: (404)616-3731 Pharmacy: (404)616-5500 www.gradyhealth.org/
Piedmont Hospital: Sixty Plus Older Adult Services- (404) 605-3857 www.piedmonthospital.org
Project Open Hand - Meal Program (Numerous)- (404) 872-6947 www.projectopenhand.org
United Way- (211) www.211online.unitedwayatlanta.org
Mental Health for Older Adults (Local)

Anchor Hospital (Supportive Care Unit)- (770) 991-6044 www.anchorhospital.com

Emory Wesley Woods Center-(404) 728-6200 www.emoryhealthcare.org/senior-health-center/index.html

GA Crisis Line - 1-800-715-4225 www.mygcal.com


National Alliance on Mental Illness (NAMI) – www. nami.org
Peach ford Hospital- (770) 455-3200 www.peachfordhospital.com
Ridgeview Institute-(770) 434-4567 http://www.ridgeviewinstitute.com/pat_serv_senior.htm

Summit Ridge (Senior Adult Inpatient Program)- (678) 442-5800 www.summitridgehospital.net
Other Resources



Stanford Chronic Disease Self-Management Program - Diabetes specific
http://patienteducation.stanford.edu/programs/diabeteseng.html
WIC Works Resources-Sample MI statements and questions. www.nal.usda.gov/wicworks/WIC_Learning.../questions_MI.pdf
Questions and Answers
Feel free to ask any questions or add comments!
References
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Bertera E. (2003). Psychosocial factors and ethnic disparities in diabetes diagnosis and treatment among older adults.
Health and Social Work; 28(1) 33-42.
Chen, Shu Ming, Creedy D, Lin Huey, & Wollin J. (2012). Effects of motivational interviewing intervention on selfmanagement, psychological and glycemic outcomes and Type 2 Diabetes: randomized controlled trial.
International Journal of Nursing Studies, 49(6):367-644.
Cummings S, Cooper R, & Cassie K. (2009). Motivational interviewing to affect behavioral change in older adults.
Research on Social Work Practice, 19(2):195-204. dio: 10.1007/s10461-011-0016-x
Dabelko H &DeCoster V. (2007). Diabetes and Adult Day Health Services. Health & Social Work, 32(4)279-288.
DeCoster , V. (2001). The psychosocial challenges of Type 2 Diabetes and the roles of health care social work: A
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