Getting Your Patients Ready for Effective Health Communications


Welcome, everyone, to today’s
webinar from the National Diabetes Education Program,
Getting Your Patients Ready for Effective Health
Care Communications: A New Beginning in
Diabetes Management. My name is Janet Brown-Friday. I am the clinical trials
manager at the Albert Einstein College of Medicine
in Bronx, New York. We are very excited
about today’s program. Continuing Education Credits will be provided only through the CDC training and Continuing Education Online System The presenter’s have no conflicts of interest to disclose. A handout will be provided once we close this webinar with specific instructions on how to obtain CEU’s. There is no charge for CEU’s provided through CDC. We have an excellent
panel of experts, which I will introduce before
their presentations. We will begin today with someone
that needs no introduction, Dr. Linda Siminerio who is a
professor of medicine and executive director at the
University of Pittsburgh Diabetes Institute. Dr. Siminerio
has led a career in diabetes research and education. She is a nationally recognized
expert on self-management education and care delivery
models in both pediatric and adult populations, and she
serves as the principal investigator on numerous
studies related to diabetes prevention and treatment. Dr. Siminerio served as
president of health care and education for the American
Diabetes Association and as senior vice president
for the International Diabetes Federation. She is currently chair of NDEP. Linda, take it away. Thank you, Janet, for
that nice introduction. I’m going to start today’s
webinar by talking about effective patient–provider
communication and give you some background. So, these are some things
that we often hear whenever we are working in our
practices or clinic, and the defenses and the
rationalizations go up. See if these sound familiar:
My patients are noncompliant. Our patient population
is different, very unique. When you use these
standardized approaches, it inhibits my critical thinking
and limits the ability to individualize my care, and
I really do know what is best for my patient. I know what’s best for
my patient, based on my experience and…ah…
the traditional role of the experienced, more
knowledgeable advisor. What we know about
patient–provider communication is that, well, we know that
patient communication (we’ve learned a lot over
the years); we know that a directed, paternalistic
approach is not effective, and improving knowledge
alone doesn’t necessarily translate to improved behavior. Literacy, health literacy,
numeracy—these are all problems. And health care
providers do not always communicate with each other. For years, we were trained to
believe that what we said mattered, and when we spoke,
patients understood and accepted our direction. And if people didn’t
do and accept, they were classified
as noncompliant. I’m guessing this
sounds familiar. An example of a communication
challenge that I heard recently is depicted
in this cartoon. I was the diabetes educator,
partnering with the diabetes specialist on a
telemedicine visit. The visits were done remotely to
provide access to our patients with diabetes in remote
rural communities. When our rural patient is having
problems with weight and following a meal plan, she
snacks throughout the day. Our very kind and well-meaning
endocrinologist said, “We have lots of patients who
have problems with grazing.” Our confused and somewhat
disgruntled patient looked at me, “Does that doctor think
I eat or look like a cow?” As someone who grew up
and lives on a farm, that’s how she interpreted
the word “grazing.” This cartoon depicts the
long-accepted relationship of the traditional health
care decision making. The provider, in the red
balloon, can be one of us— the physician, the nurse,
the educator, the dietitian, the pharmacist—and the other
green bubble is the patient. Of course, this pathway in the
large green bubble lends to a provider-driven decision. So, what does the
literature tell us about patient–provider communication? First, let’s ask ourselves:
Are we empathetic? So, what do we know? Studies published in
obesity are just one example. Physicians, we know or have
learned, build less rapport with people who are overweight
or obese, and this leads to some interesting
insight on empathy. This particular study
was aimed to describe the relationship
between patients’ BMI and physician
communication behavior. They used audio-recorded
encounters from 39 urban PCPs and 208 of their patients. The researchers examined the
frequency of communication behaviors between the
doctor and the patient. What they found was patients… the PCPs demonstrated less
emotional rapport with overweight patients than for
their normal weight patients. And for those of us working in
diabetes, this certainly offers big opportunities for gaps
in communication in caring. What about patient satisfaction? In this particular
study, they looked at, are patients satisfied? Fifty-two percent of the
variance in ratings of patient satisfaction with medical
care was accounted for by the physician’s
level of interpersonal warmth and respect. A study involving diabetes
patients found dietitians’ empathetic engagement with
patients with diabetes to be a predictor of
patient satisfaction and successful consultation. Another study found that empathy
is the most important quality for being considered
a good physician. Interestingly, patients who
don’t have decision support blamed their practitioner for
bad outcomes 19% more often as compared to a
physician who they feel is empathetic and respectful. The Institute of Medicine
gathered a team of experts who worked to develop strategies to
guide evidence communications about providers and patients,
this communication that holds the
potential to yield better care. And what they found from this
expert committee is that this seeks to improve the
public’s understanding of the discussion of the
nature and use of evidence to guide clinical choices. This collaborative was very
inclusive of participants, communication experts, physician
scientists, patient advocates, health system leaders, health
care providers, and more. The work took place in a number
of distinct cities across the United States and scanned and
surveyed and found interesting information on people’s
attitudes and their beliefs. And I direct you to this website
because there’s a plethora of information based on what this
consultative group found in their surveys and their
environmental scan. One of the interesting things
that I noticed in reading information from this particular
documentation is that there was a gap between what people want
and what they get regarding engagement in health care. Interestingly, 8 in 10 people
with chronic disease want their health care provider
to listen to them, but only 6 in 10 say it actually happens. Less than half of people say
their provider asked them about their goals and concerns
for their health. And 9 in 10 people want their
providers to work together as a team, but only 4 in 10
say it actually happens. What can we do? Well, one of the processes that
has gained a great deal of attention is shared
decision making. And shared decision making is
defined as a collaborative process of patients and their
providers to make health care decisions together, taking into
account the best scientific evidence available, as well
as the patients’ values and preferences, and doing
this in a collaborative way. There was a Cochrane review
of 86 clinical trials of those patients who use shared
decision-making aids. And what they found within this
meta-analysis was there was improved knowledge of options;
there were more accurate expectations of possible
benefits and harms; there was greater participation
in the decision-making process; higher satisfaction, which all
of us are challenged through all of our health care
systems to demonstrate; and choices resulting in lower
costs and better health outcomes when decisions were
made collaboratively. I’d like to direct this next
part of the conversation to some work of a friend and colleague,
who I consider to be an expert in exploring the use of shared
decision making to empower underserved people
with diabetes. And Dr. Monica Peek, who
has done her work at the University of Chicago,
has really used the patient empowerment model as a
theoretical philosophy, a groundwork, for her work,
because she realized that self-management is key to
diabetes care, and most of that self-management happens during
the person’s daily life, 24/7, outside of the physician’s
office or the dietitian’s office or weight management educator. The shared decision making needs
to happen with providers, and providers need to be
educated and empowered to also perform shared decision making. She also realized that diabetes
self-management interventions are accepted in minority
populations, and she based a lot of her work on
all of the literature that’s available on this. But what she did realize is
that there was no prior work looking at shared decision
making with culturally tailored patient education, and
she wanted to determine if shared decision making
improves outcomes. So, to walk through the domain
of the shared decision-making process, the first piece of
shared decision making is about information sharing. So, information is important,
but again, all of these processes need to
lead to behavior change, so it’s giving information. This is what an A1C is. This is why an A1C is important. The next step in the
domain is deliberation. Why is this important for me? How often do I need
to get it tested? What does it mean if the number
is high or within a range that is supposed to be
a target range for me? And then make a decision
together and implement it. Well, she also realized,
Dr. Peek, is that shared decision making
is central to the chronic care model. And this is the model
that’s being used throughout the country as the formation
through what many of us refer to as patient-centered
medical homes. And the chronic care model
has been used in many, many primary care practices, in
health care community settings, because it contains
elements that we weren’t paying attention to for many
years: self-management, population-based management,
and community care. Shared decision making
does correlate with positive health indicators. It gives better
diagnostic accuracy. It helps informed consent. It has been shown to
improve glucose control, lowers blood pressure,
shorter hospitalization. And even though some folks will
argue that it takes more time, actually it’s been shown that it
provides more efficient and effective visits; fewer,
interestingly enough, malpractice claims; and less
doctor swapping, because the patients are engaged
with their physicians. And it has very big implications
for processes that are involved with patient-centered
medical homes. When you think about it, an
average physician has over 160,000 patient interviews
that they participate in. This is just an example of, and
you can refer to this slide, of many, many organizations
that are jumping on board who appreciate that we need
to start using these kinds of approaches with communication
with our patients. And I refer to you to another
slide that has the publication that Dr. Peek first prepared
that reviewed the barriers and the facilitators to shared
decision making among the population that she
worked with in Chicago, African Americans with diabetes,
but many of the lessons learned by Dr. Peek are applicable to
the patients that we work with in our own communities. What she found in her work—and
these are just some key nuggets that I pulled out—is that there
is often a power imbalance. We many…almost all of our
cultures still have that hierarchical feeling. This is the doctor. I’m the eager patient here. This is where we need to
empower our patients that we’re equal partners. They’re the ones that are in
charge of their own health. She also recognized that one
of the barriers was health literacy; limited self-efficacy;
trust; some fears and denials; and, of course, challenges
with normative beliefs; and providers fearing that the
length of the process would take longer when these kinds of
communications occurred when the evidence tells us
that’s not the case. Some of the facilitators
[inaudible] shared the decision making process is patient
engagement and an invitation for open communication and
transparency, improved interpersonal relationships,
validating the person’s health concerns, and
accessibility and availability to have that open,
transparent conversation. This slide has the things
that Dr. Peek had heard and were quoted from some
of the studies that she has done using her model. These may sound familiar. “The doctor told me I need
to go to the dermatologist. Now, the lady up there at
the desk, I told her that I don’t want to go.” So again, the patient felt more
comfortable with the person at the desk, and often as
educators, many times, the patients will tell us things
that they don’t feel comfortable sharing with their provider. The patient said that “If
this skin growth goes down, then I don’t see a
reason to operate. So, I’ll have to think about it. Well, I didn’t tell my
doctor about my preference for not messing with it. I just told her that I
would go through with it.” Another finding. A quote: “Some African
Americans still don’t believe in everything the doctors say. I have a neighbor and she goes
to the doctor, and when she gets medication, she throws
it in the garbage.” Happens with many,
many of our populations. Some elements of Dr. Peek’s
program that you may find applicable to use in your own
work or applicable to use in the New Beginnings Program:
First, it’s a 10-week program; it is culturally structured. It included, of course, diabetes
education that is intended to culture that used shared
decision making, and you’re going to see some actual videos
on shared decision making. It included the basic
curriculum, get to the key points of what we
need to communicate about good health care, used
adult-learning principles, and was very, very attentive
to health literacy. The shared decision-making
steps: Ask more questions; give more information,
evidence-based information; clarify physician information,
make sure the patient understands, repeats, can
speak back to you what you’ve communicated; and communicate
health care preferences. Although the physicians,
our educators, our dietitians, nurses, etcetera, can advise the
patients willing, only those willing, to do what they are
able to accept as a plan as a priority in their care. Again, information sharing,
deliberation, and decision making to be implemented
by the patient. Another thing that Dr. Peek
found is very important; we know that any intervention
that we do that involves self-management needs
ongoing support and she used support groups. This is a summary of the
findings from her study—and again, you can refer to this
on the slides that will be available to you
on the NDEP site. And these are just some
summarizing quotes on how people felt after the program: “It changed how I
interact with my doctor. By me seeing the video,” that
you’re going to be seeing, “I did have the presence
of mind to ask.” “They kind of built me up
in the program—we’d be like we were at a doctor’s session
and then my doctor would say things that she knew is
not right either, but then she wants to know, are we
going to catch on to it and just let it go or
will we speak up?” So, in summary, building
a shared decision making foundation, again, one strategy
posted in the literature, empowers patients. Let them know they have
value, that their opinions are valuable and why. Tell them about the three Ds:
discuss, debate, decide; increase expectations
about involvement in care; continue shared decision
making throughout the visit; address uncomfortable
barriers, like trust, perceived discrimination,
cultural differences; and involve the staff so they
understand the process with meetings, resources in the
waiting room, precoaching visits with other staff, and of course,
interaction and integration with other health members of the
team like diabetes educators. Thank you, and I would like
to move on to a colleague and friend, Alexis Williams,
who’s going to talk about the New Beginnings Discussion Guide:
Approaches to Teaching Psychosocial and
Interpersonal Skills. Welcome, Alexis. Thank you, Linda. Lots of insights. As you were talking,
a couple of questions came through the chat box. So, I wanted to ask you one of
the questions if you don’t mind. This question came in from Leah
Anne Miyagawa and says, “Did Dr. Peek use motivational
interviewing with SDM? How are these concepts
similar and/or different?” You know, I think all of
those techniques are similar. I think there’s just nuances in
maybe some of the strategies, but I would have to say
that that’s the thread that’s similar is that empowering
the patient’s thread that runs through all of those
conversations. And I think the other key thing
that happens to every one of the strategies, the shared decision
making, empowerment approaches, and motivational interviewing
is taking the time to listen, really listen to what our
patients are telling us and being able to demonstrate that
we are willing to listen and willing to act on
what they’re telling us. Thank you. Thank you again, Linda. That’s great. Now, we will continue our
program with our dear colleague, Alexis Williams, who is a
public health adviser at NDEP. Ms. Williams develops and
delivers training and technical assistance for NDEP, working
with CDC-funded programs, partners and community-based
organizations to help strengthen their capacity to
deliver effective diabetes prevention and control programs. A certified health
education specialist, she holds a bachelor’s degree in
sociology from Mills College and a master’s of public health
and behavioral science and health education from
Emory University in Atlanta. Alexis, the floor is yours. Thanks, Janet. Hi, everybody. Welcome to our webinar today. I’m so glad to have so
many of you on to talk about this really important topic. And thanks, Linda, for really
setting the stage for what we’re going to talk about in
the rest of the webinar today, which is actually how we begin
to apply some of the concepts when we’re teaching, when we’re
providing health education or patient education. What I’m going to do is talk
about some of the frameworks that we use in New Beginnings
and really the kind of frameworks that you can use when
you’re approaching any kind of instruction around
psychosocial or interpersonal skills
like communication. So, I really am enjoying
watching this show called the Worst Cooks in America. And I think this is a really
good example of the traditional kind of education that
Linda was talking about in her presentation. The idea of the show is
that people are bad cooks, the participants in the show are bad
cooks, and so the solution is we’re going to teach them how
to cook, and we’re going to have them watch a subject
matter expert cook something like Hollandaise sauce. They’re going to take notes, and
then they’re going to go back to their workstations and replicate
the dish, and whoever does the best wins, and people who
can’t improve or don’t improve or don’t have the best dish
end up leaving the show. And the people who are
the best at the end, end up winning the whole show. And I think this is really how
we have tended to approach education—health education. A knowledge problem requires
a knowledge solution from a subject matter expertise…
from a subject matter expert. So, maybe there are some other
things that we need to address, maybe it’s not just
about knowledge. Take a look at the participant
from last season here. This is Donna. Donna is trying to make
her Hollandaise sauce. She’s wearing two pairs of
glasses, and she’s saying, “I forget where I am, while
I’m at where I’m going.” What do you think might be
going on with Donna besides the fact that she doesn’t know
how to cook Hollandaise sauce? If you think there are
any issues with her besides a lack of skills for cooking? [READING AUDIENCE
RESPONSES FROM CHAT BOX] Thinking ahead too much,
overwhelmed, stressed, anxiety. She’s juggling a lot;
she’s overwhelmed, overwhelmed, poor memory. She sounds flustered, maybe she
needs a checkup on her eyes, memory problem. Multitasking, focusing on too
much, vision problems, anxiety, stressed, disorganized,
lacking confidence. Poor Donna has a lot going
on besides the fact that she doesn’t know how to
cook Hollandaise sauce. I would propose that the
participants on the show are not bad cooks, but they have
other issues going on with them that are impacting their ability
to learn cooking skills. They’re scared. They have failed at cooking so
many times before that they are scared that they are going
to continue to fail. They have low self-efficacy. They don’t have any confidence
in their ability to cook. They don’t think they can cook. They don’t think they’ll ever
be able to cook, and the people around them have told them
that they can’t cook and have made fun of them, and
the stories of their bad cooking are legendary. Which means they have
trouble communicating. They have trouble communicating
with their family about how this makes them feel. They have trouble communicating
with the subject matter expert. They have trouble
understanding the recipe. They are stressed—not just on
the show, not just being on TV, but when they start to
talk about their lives and what has brought them to
the TV show, you realize they’re stressed in their
personal life, as well. They’re disorganized, and
they lack cooking skills. They can’t cook. But maybe at the heart of
the issue, it’s not just the cooking skill. They are also highly motivated
to change their behavior, not just by the prize money, but
they all talk about the reasons that they came on the show is
that they have linked this, their ability to cook, to some
core value like being a good parent, being a good partner. To their health, the fact that
they can’t cook means they eat out all the time, and
it’s having a negative impact on their health. And so their need to learn
how to cook has driven them to go on the show. It’s not much about the money
but that they have linked their poor cooking skills to some core
values that’s motivated them to come on board. Does this sound like any
patients or participants or clients that you might have? I think that we all, when we’re
teaching, run into people who it’s not just about the
knowledge, it’s not just about the skills, but they have
a lot of other things going on. And we actually have
trouble getting to the skills, getting to how you make the
Hollandaise sauce, because we need to address all
of these other issues. The fact is that most of
the people on the show, all of the people on the
show learn how to cook. The ones who win are the
ones who have the greatest increases in self-efficacy
and the greatest increases in learning how to
manage their stress. So, they start to win; they win
one or two cooking dishes, and they start to think,
“Oh, I can cook.” And they learn how to organize
their cook stations and those are the people
who go on to win. Everybody on the show learns to
cook something, but the people who win are the ones who
have the biggest increases in self-efficacy and
stress management. So, diabetes management, the
point of this story, is that diabetes management is not
just about Hollandaise sauce. I mean, when we go to teach
people any skills about their health, it is not just about
here are the basic skills for healthy eating and physical
activity and monitoring and all the other things we try to
teach people, but we also have to address important core
interpersonal skills. We have to find ways to
support motivation; we have to find ways
to support self-efficacy. We have to find that link to
personal core values that are really going to motivate
people to want to change their behavior and start to build up
the interpersonal skills that they need in order to
address these issues, as we need to do all of that on
top of the knowledge transfer. So, what is useful… what will
be useful to us is to have the kinds of tools that support
these kind of interactions and these kinds of instructional
approaches. So, not just, here are the
things that you need to teach people about the food plate or
about what counts as moderate physical activity, but tools
that will actually help us to begin to support a person’s
self-efficacy or a person’s communication skills or a
person’s ability to be more organized and less stressed. This is really at the heart
of New Beginnings, which is A Discussion Guide for
Living Well With Diabetes. It’s a resource for diabetes
educators, community health workers, health educators,
anybody who provides education to people who have diabetes
and their family members. This does not replace diabetes
self-management education, but it’s intended as an add-on,
and it’s really focused on managing the emotional
side of living with diabetes. So, how do you deal with the
impacts on your own feelings, your own self-worth? How do you manage the
impact on your family? How do you develop meaningful
social support structures and improve communication with
providers, caregivers, and loved ones? The New Beginnings Guide
has been tailored for African Americans. We’ll talk a little bit
about how we do that. The primary way is
through stories of African Americans with diabetes. One of the things that we
recognize is that in talking about that all populations, all
groups have issues when it comes to discussing new kinds of
interpersonal and psychosocial and emotional issues. And what we need to do is
find ways to bridge those communication gaps, to make it
easier for people to talk about what’s going on with them and
to talk about things that are frankly considered somewhat
taboo to talk with people outside of your community
or outside of your family. New Beginnings has eight
modules, and they cover a variety of topics around
emotional coping, self-efficacy, stress management, problem
solving, and communication. We’re going to focus
on Module 8, which is “Working With Your
Health Care Provider, Working With Your Doctor, and Improving Your
Communication Skills.” But the…the sort of
psychosocial approach to teaching these is carried
throughout all eight modules, and they’re very flexible
and adaptable modules. You don’t have to do a whole New
Beginnings eight-week course. You can adapt with the need,
whatever your needs are, you can pull out one exercise
and do one exercise in the program you’re
already running. There are a lot of ways
to use New Beginnings, which Peg will talk about later. At the heart of New
Beginnings is storytelling. So, all of the exercises, all
of the modules are linked to a particular story of a
person who is trying to or family member who is trying to
help someone with diabetes, or a person who’s trying to
live with diabetes, and then we have a discussion
and activities that are built around the story. And the reason we use
storytelling is because it really supports
communication. It helps people overcome
that personal barrier to talking about that
emotional thing that I’m not supposed to talk to
other people about, because they can talk about the
character in the story; they can talk about what’s
going on with them without having to disclose personal
information about themselves. It really helps to
break down some of those communication barriers. The stories also help to model
behaviors so people can see someone who’s either doing
something really well or struggling with something, and
people can see how someone else deals with that and start to
think about how they can cope with that in their own lives. And it can also help bridge
cultural divides when there are differences between the educator
or the group leader and the people in the group or the
patient that this story becomes a shared experience that can
help break down some of those communication divides
that…that sometimes arise. So, the guiding principles of
New Beginnings, what we really want to talk about and getting
back to some of the things that Linda talked about and some
of these core concepts that we want to keep in mind are
around adult learning theory, promoting self-efficacy,
and motivational interviewing. The stories and the discussions
in New Beginnings are driven by these concepts. And you don’t have to go out and
take a training on motivational interviewing; we have built
these concepts into the lessons. So, if you follow the lesson
plan, you will begin to start using some of these skills
and applying some of these skills with the
people in your group. So, in terms of the core
concepts and the principles that are used in New Beginnings,
adult learning theory and the principles of adult learning
recognizes that adults come to the table having already learned
a lot, having already advanced a lot, and we need
to respect that. So, the New Beginnings
discussions really involve the participants in deciding
where these discussions go and how the discussions go. So, you show the story, and
you don’t tell people what the story is supposed to mean or
what the moral of the story is. It’s not that kind of approach; it’s now let’s talk
about what happened. And in talking about what
happens, people will pull out the message that’s most
relevant to them, to the story. And it helps them begin to be
more self-directed in terms of the areas they want to
explore, the areas they want to talk about, and
how that discussion goes. New Beginnings focuses on the
relevance and the impact of the skills that we’re
trying to teach on the participants’ lives. So, it’s not sort of
unrelated skills that you think I need to learn as
a health educator. So, what skills are
important for you? What’s going to help you when
you leave here today to do a better job or to have better
communication with your family members or to have better
communication with your… your health care provider. It draws on the experiences
people already have. It draws on the successes and
tries to build on any successes that they already experienced,
and every New Beginnings module includes hands-on
problem solving. It’s really important for people
and adult learners and for certain cultural groups—for men,
for African Americans, for Hispanics/Latinos, for some
other cultural groups—for things to be really concrete and
hands-on and not, sort of, we don’t want to sit
around and talk about our feelings—that’s
not what we do. But, here are some specific
skills, some things that you can take away and that
you can apply today. So, that’s really some… some
really important concepts that we draw on from
adult learning theory. We also really have a
big emphasis on building self-efficacy in New Beginnings. If you don’t believe that you
can accomplish a skill, that you can make a change,
then it’s not going to happen. It’s just my belief,
as a health educator, that self-efficacy lies at the
heart of almost all of the changes that we’re asking people
to make is that they have to believe that not only is it
important to make this change but that they are capable
of making this change. So, in New Beginnings, we use
social modeling through the story to build self-efficacy,
so you see people like you making these
kinds of changes. We encourage mastery
experiences, and mastery experiences are
quick wins to help people build their confidence. So, you start to take small
steps and see you can do it, and that’s just one step
to a bigger success, and we try to reinforce
those quick wins. We do the discussion,
we do the activity. The participants are able to
break down a new behavior into manageable steps that they
can…that they can practice. As…know what we said about the
Worst Cooks in America show— the people who win are the ones
who have these quick wins, and they start to build…those
wins build upon themselves until you finally feel like you can
be successful with something. People are encouraged to
overcome their self-doubt, the stories and discussions are
really there to help people work through that
negative self-talk and replace it with
positive self-talk. To be a good friend to yourself
and to encourage yourself and to build yourself up and
to not be beat down by minor setbacks—that’s
all they are. Every day is a new beginning. That’s our motto for the
program, and you get another chance to try again, and
next time will be better. And we also focus on
stress management and developing positive
coping skills. The third sort of core principle
that…that’s a part of New Beginnings is
motivational interviewing. And without training our
facilitators to go out and become experts in motivational
interviewing, what we have tried to do is to build
some of these concepts from motivational interviewing
into the discussion guide. So, motivational interviewing
is—for…for people who are not familiar with that…
that approach—is a participant-centered
communication technique that’s designed to build
internal motivation and self-efficacy for
behavior change. It’s really to help people
overcome their ambivalence to change—that “I’m feeling two
ways about something,” that “I know I need to
walk more, but…” And it’s to help people overcome
that…that “but” and to sort of lose all of those reasons
why they can’t do something. And to start to talk about
the reasons why they can do something and why
they will do something. So, we do this in New Beginnings
by using open questions. So, those are
questions that can’t be answered with a yes or no. That helps participants
do most of the talking and drive the discussion. It’s really important for people
to be driving the discussion and not the facilitators. And it also helps participants
start to tell their own story, and this can help
support change talk. Change talk is when a
participant starts to state what they should change,
why they should change— instead of the facilitator. So, it’s not me, as the health
educator, coming in and saying, “OK, now you are going to
learn to read food labels and be able to count
how many calories.” If that’s not important to
you, then you’re not really going to be that
interested in it. What change talk is,
is a participant saying, “Well, what would really be
helpful is if I did a better job of reading the food labels
before I bought something.” We want the participant to state
a change they’re going to make, and so the stories and
the discussions are really designed to elicit
that change talk. And we also try to
normalize challenges. So, the stories help normalize
that it’s…it’s difficult to learn to manage diabetes. It’s stressful and it’s okay. That is normal, and it’s
expected that from time to time for you to feel overwhelmed, for
you to feel stressed, for you to feel angry
or sad or frustrated. Those are all normal, and
you can work through them. And so what the stories and the
discussion really help to do is normalize what the
participants are going through. They see people who are
facing similar challenges. Change is hard for everyone, and
normalizing helps participants move away from blaming
themselves to more… taking more
constructive actions. In terms of how this is applied
in improving patient–provider communications, the Session 8
focuses on two key concepts: partnering with your diabetes
care team and partnering with your caregiver or your family. So, in terms of partnering with
your care team, we focus on building the participant’s
self-efficacy and the patient–provider encounter. You are the person in charge of
that encounter, and by being prepared, you can come in and
get what you need to get out of that meeting with the provider. And so, we help participants
prepare for their visits with their health care providers. We also help participants
learn to partner with their caregivers and families. And this is important for
helping them to get more social support for their
health care visits so that if they need someone to provide
moral support or someone to come with them to help them
understand, to help them communicate with the health
care provider, they are able to communicate that in a way—with
their family or their caregiver—in a way that
they can get what they need. It’s also designed to help
reinforce patient progress so that family members are
focused on the right thing and the helpful things and the
useful things to help build up the person’s self-efficacy and
to help support the person in meeting their behavioral
goals that they have worked to set with
their health care provider. And recognizing that
patient–provider communication is not a one-way street—that
it’s not just on…on the patient to improve that…that
communication relationship, but it is also on the provider. We also try to set up some
expectations for what those encounters look like in the
New Beginnings sessions. So, you can teach people skills,
improve communication skills, but you can also model how a
facilitator or an educator or a provider who is practicing
those communication skills, what that looks like as well. And set some expectations
of what those kinds of relationships are like. So, we reinforce in New
Beginnings that it’s mutual respect, that the participants
and the facilitators are all there working together,
and so you create an air of mutual respect. We come to mutual understanding. Facilitators make an effort
to understand their…their participants and where they’re
coming from, and the stories really help to build up
that mutual understanding. You come to common
agreement on goals. Participants set their own
goals—it’s not someone else setting goals for them. And you may talk back and forth
about tweaking those goals or making those goals relevant,
making those goals meaningful, impactful, and achievable. You provide a
supportive environment. You provide the right
information at the right time—not all of the information,
but the information that participants need at
the time to address the issues they are having. We reinforce the importance of
transparency and full disclosure in New Beginnings sessions, and
we also set up the sessions so that people have regular
feedback on their progress and the progress of the course. So, how am I doing as a
facilitator and are you getting what you need, so that
we can make assessment and course correction as
needed in that session. And so that the participants
leave having this kind of relationship with the
facilitator that they would hopefully expect to see
in a relationship with their providers, their
health care providers. So, just to summarize, the way
that we approach patients’ psychosocial skills in New
Beginnings is not just basic skills but interpersonal and
psychosocial skills as well, with a big emphasis on
motivation and self-efficacy. And we base this on adult
learning principles through the use of storytelling and
learner-centered techniques. Thank you. Alexis, I want to thank you very much for that
great presentation. I’m sorry. You can talk. What’s going on? Well…and I just thought…and
I think I didn’t clarify—and I meant to go back and clarify—
that the basic framework for New Beginnings can be used with
a lot of different populations. We’re actually in the
process of adapting it for other populations. The stories feature African
Americans, and they feature, sort of, language and family
interaction5s and attitudes and beliefs about health care
and managing your health and how you are supposed
to deal with emotions from an African American perspective. And so that’s why we say that
New Beginnings is tailored for African Americans, because it’s
been culturally adapted to the way that we, African Americans,
tend to think about things like stress and how you’re supposed
to cope with stress and how you’re not supposed to talk
to people about how you feel. And so, it’s been designed…and
these are not issues that are unique to African Americans,
we recognize that. And what some other facilitators
do is they use stories that are meaningful to the population
they’re working with. So, we have people in American
Indian communities and Hispanic/Latino communities, and
they have adapted the stories or chosen their own stories
to reflect the cultures of the population
that they work with. We had some rural communities
as well who have done some stories that are…are
unique to rural communities. And so that would be the way
that you would adapt this, these stories to meet the
needs of your population. Alexis, thank you again. I have one question from
Rebecca Sutherland, which is, “Are there parallel
evidence-based programs designed for preventing
early onset diabetes? Is this program effective at
preventing early onset diabetes among family members,
caregivers who participate with program participants?” Those are some
really great questions. So, the National Diabetes
Prevention Program, which you can find more information
about on CDC website,, the curriculum—the approved
curriculum—for that program includes things like stress
management that is a diabetes prevention program for
people with prediabetes and that includes things like stress
management, self-efficacy, communication, organization,
and problem solving. So, those kinds of psychosocial
issues are built into that evidence-based…and
that… that prevention program is evidence based. So, you can find
more information about that on the website. New Beginnings also encourages
people to bring their family members, and so, within the
guide, we have added some resources for people who
might be concerned about prevention among…among
their family members. So, encouraging their family to
start to take steps to reduce their risk for type 2
diabetes—that is included in the New Beginnings
discussion guide. Although the focus is not
specifically on diabetes—that type 2 diabetes prevention—we
do try to provide some…some resources for people who
have an interest in that. Thank you. Thanks again, Alexis. Now, I would like to introduce
the last presenter of the day, Margaret B. Thearle. Ms. Thearle is a certified
diabetes educator at the University of Pittsburgh
Center… Medical Center Physician Operations. She’s been working in adult
diabetes care for 15 years. In her current role, she
consults and collaborates on projects that include
professional staff training, member self-management
education, community outreach, and quality initiatives
for population management. So, without further ado,
Peg, please go ahead. Thank you. Thank you for giving me
the opportunity to share my experiences using the New
Beginnings discussion guide. I’m very passionate about
talking about diabetes. I had a great opportunity in the
fall of 2014 to partner with UPMC Health Plan and the
University of Pittsburgh Diabetes Institute and local
community health centers on a diabetes outreach project. Here you see the recruitment
flyer that we used, and the flyer comes…it was
adapted from some of the promotional resources that were
available in the New Beginnings guide information, and we were
advertising that you don’t need to be a superhero to
manage your diabetes. We’re trying to reach out to
people living around poor urban community centers in the Greater
Pittsburgh area, and the program was open to anyone
interested in learning about living with diabetes. The program was free, and
it included a healthy lunch, which was coordinated by Janine
Jones, one of our dietitians, and CDEs from the health plan. As you can see from the flyer
information, some of our goals were to help participants
learn skills for planning, managing stress, and
communicating, as well as coping with the ups and
downs of managing diabetes. We also wanted them to learn
about getting that support that they need from
health care providers, as well as family and friends. And we really wanted the
participants to know that this would be a fun and
supportive group setting. Our overarching theme was that
every day was a New Beginning and a chance to do a little bit
better to live with diabetes. So, we really did embrace a
lot of the themes from the New Beginning concept. We kind of modified the New
Beginning Discussion Guide for Living Well With Diabetes as
a model for our program. We—unlike what Alexis mentioned
in the eight sessions—we had to modify that to a
four-session program. So, we adjusted a little
bit, and the New Beginnings program could be very adaptable. We modified that to
four-session program. We used four sessions of 90
minutes, and our key objectives were taken from the guide. We consolidated that for major
content areas, and the program focused on the emotional
aspect of managing diabetes that involved both the
persons with diabetes and their loved ones. And accurate information about
current diabetes management was incorporated at every session,
as well as building those skills for developing
action plans. So, at each session, you can
see the session topics here, as you can see listed
on the flyer information. Session 1 was focusing on living
with diabetes, living well, and we introduced the concept
of the ABCs of diabetes care. And in Session 2, we were
talking about coping with emotions, self-doubt,
and stress, much of which Alexis spoke about. Session 3, we were talking about
making those smart plans, and we’ve…we practiced
that—problem solving, handling those ups and downs. And we talked a little bit about
emergency preparedness. We also, in Session 4, we talked
about developing those support networks in working
with your doctor. It was very important to build
that trust and maintaining that privacy, creating
a nonthreatening, supportive environment. That was a crucial
part of the program. And actually, it was a part
of a guide…a recommendation from the guidebook. And the participants on
the first session set up ground rules, which
they themselves were very instrumental in doing, and
some of the things that they agreed upon was that everyone
was entitled to their opinion, their own beliefs, and
that all the participants would be nonjudgmental; they would not criticize
or offer unsolicited advice. In the program,
attendance was open. Participants were not required
to attend all four sessions. The New Beginnings, for those of
you who are diabetes educators, this was not intended to
replace traditional diabetes self-management
education program. For our purposes, however,
we did not solicit to do that. But as a diabetes educator, I
found that this New Beginnings guide was a very useful tool,
which…which I feel could be used for diabetes
self-management education, as I have a lot of
experience in providing that kind of
program…program use. As a matter of fact, I feel
it could be used for any group that’s already meeting. It was very adaptable. It had a lot of the activities,
and discussions could be used for any group. It was easy. The guide itself had…all
the homework was done for you. Their…the programming was
very, very easy to follow. The access for the resources
was already included. It was easily…to modify
to whatever content or curriculum you already had. All the worksheets, discussion
guides, and exercises that you need to implement
for the program are included in the guidebook. And the guidebook
is available as a PDF; it’s available as
a…as a booklet. There’s a lot of hyperlinks
embedded, so by going to the website, you can get
whatever information you needed. Actually, we did a lot
of turning the stories into role plays, which
gave the participants an opportunity to
act out situations. And with a little bit of
creativity, we were able to personalize some of the
themes by adding some, you know, local events,
sports themes, holidays— keeping the stories real. We, here in Pittsburgh, can
really relate to any story that has anything to do with our
cherished sports teams such as our recent Stanley Cup
Champion Pittsburgh Penguins. We… made available Terri
DeFazio, who’s our program manager for our program,
was very diligent in trying to provide a lot of resources
throughout the sessions. And we made a lot of resources
available so that participants could choose whatever they found
helpful or useful for them or their family members. A lot of resources available
out there from the NDEP site, including a lot of
literature, which is available to be downloaded. There were a lot of resources
that we chose from our own national local public health
departments, including some information about free
clinic availability, community support programs,
information from our local American Diabetes Association. We felt it was important to help
connect them to resources that they may need at their avail
and contacts for how to find a diabetes educator
or diabetes program. And also, because we were
working with the health plan, we wanted to make them aware of
what programs were available for diabetes information related to
diabetes prevention and health coaching and disease
management programs through the health plan itself. Storytelling was really, really
an integral part of the program. And I’ll tell you,
as an old dog, it really taught
me some new tricks. After observing the storytelling
videos, at each session, participants were open to
sharing their feelings. As an educator, it was
a sit-back moment. Discussing characters, thoughts,
and feelings in the third person was really less intimidating
for the participants. These interactive discussions
created an open, nonthreatening environment for vetting feelings
and for them to talk about obstacles and barriers. Participants could often
relate to the characters. They could share their
situations, their challenges, their family dynamics. The video characters
often demonstrated positive behavior changes. And this provided some
realistic role models. For instance, the
character on the right, the woman on the right,
her name is Sorcy. She’s actually a Hispanic woman. She tells a story of discovering
that she had type 2 diabetes only…she only found out
she had type 2 diabetes after she developed multiple
diabetes complications. She was a staunch
advocate for engaging her entire family in
lifestyle changes. She wanted to prevent her
daughters from developing diabetes health problems. In this picture, you see her
playing with her family using a Wii Fit Boxing Program. Building on these observed
behaviors really helped the participants to begin to talk
about and internalize and develop strategies for
personal action plans. In this picture, these
participants are watching a clip from a video called
“The Debilitator,” which is obtained from
Millennium Filmworks. In a dream segment,
the character, Calvin, he dreams about his early death
from diabetes complications and the impact that
this has on his family. The emotional interaction
between Calvin and his family had a powerful influence on the
follow-up group discussion about feelings and
personal interaction. And this was a great
lead-in to talking about developing support networks. After that discussion, many
of the participants were moved to share their own personal
experiences related to health disparities and
some of their concerns for their risks and concerns for
their loved ones with diabetes. These emotional interplays
were often a major catalyst for developing personal
behavior change talk. It was really moving for me to
begin to see the people in the class, in their environment,
begin to actually move toward a discussion about their need
to start to make changes in their diabetes care. I want to share with you that
we had brief evaluations after each session, and of all the
sessions across the board in all four centers, Session 4,
Developing a Support Network and Working With Your Doctor,
had the most impact. After the session, 100% of the
participants reported improved confidence in working with
their health care team. I want to take a moment to
share with you a video that we used to start the session. And I’d like to thank Dr. Monica
Peek from the University of Chicago for allowing us
to use this video, which is a part of her work. Hello Mrs. Robinson,
how are you doing today? I’m fine, thank you and you? I’m well, thanks. How have you been? I’ve been pretty good. Good, good. Have you noticed anything
unusual or different about how you’ve been feeling? No, everything’s about the same. And have you been
taking your medication and checking your diet? Well, yes. I’ve been pretty good. I’ve been eating all my
vegetables because I know you said that was important
and I’ve been taking all my medications too every day. Okay, that’s great. That’s really important
Mrs. Robinson. Are you experiencing any
fatigue or other symptoms? No sir, I feel about the same. OK. If everything’s the same,
let’s keep you in your current medications and you can come
back and see me in three months. Grandma, did you tell him
about the sore oin your foot? It’s just a little sore;
I don’t think there’s anything to worry about. She has a sore on
her foot Dr. Woods. She says it hurts and
she’s tired all the time. You have a sore in your foot? Uhumm. Well, have you been wearing
proper shoes and checking your feet every day? Yes I have. Alright, then,
let’s take a look, OK? Well, it’s just a little sore. It don’t even hurt that much. It’s on my right foot. Well, I do see some redness and
some signs of infection. I believe that’s a result of
your diabetic condition. Now the infection is still
in the early stages but it’s important we address it
because some serious problems could occur as a result. OK doctor, I understand. There are two ways to handle
the problem with your foot. I can give you some antibiotics,
which should clear the problem, or you should see
a foot specialist. You know I think I’m going to
have you see a foot specialist. Whatever you think
is best doctor Woods. I’ve got a referral slip for
you to see a foot specialist. Call his office, make an
appointment and they should take care of you. Oh, I can’t see the foot
specialist today? I have to make an appointment? Yes. I’m afraid so. But I have to work all week and
I don’t think I can take off another day so soon. Mrs. Robinson, I’m sorry for the
inconvenience but we don’t have a podiatrist in this office
so you are going to make an appointment to call. Okay, I will call
as soon as I get home. Great. Glad to hear that. You know is also a time
for your flu shot. So I’m going to send
the nurse in and she can take care of that for you. Okay doctor, thank you. You have a nice day. Mrs. Robinson? Grandma never made
that appointment. What happened in that
Mrs. Robinson video? Is…Mrs. Robinson goes to the
doctor with her granddaughter, and during the visit, the doctor
asked her, “How’s everything going,”
and she says, “Everything’s just fine.”
“Any changes?” “No, everything is the same.” In fact, the doctor said,
“Fine. Everything is the same. Keep doing everything
you’re doing.” And then the small granddaughter
says, “Grandma is tired all the time, and she has
a sore on her leg.” And, of course, the grandmother
frowns at the little girl. And the doctor looks at the sore
on her leg and says, probably speaking at a higher
literacy than grandma’s used to, “I think this sore is coming
from your diabetes condition. And we could do two things. We could treat you with
antibiotics, or I could send you
to a specialist.” And without consulting her said,
“No, I think I have decided. I’m going to send
you to the specialist.” And then without
discussion says, you know, “Here’s the referral. You’ll have to go to
see the specialist.” And the woman says,
“I don’t think I can take time off work to do that.” And he frowns at her and says, “You need to take
this seriously.” And then he says, you know,
“Here’s the referral. Contact the doctor. Call and make an appointment. You need to take these
kinds of things seriously. And by the way,
while you’re here, we need to give
you your flu shot.” So, at the end of
the discussion, you can see the
nurse walks in. Mrs. Robinson
has left the office. At the end of that discussion,
or at the end of that video, that video had a major impact
on a lot of the participants. It was kind of an example of not
shared decision making. Mrs. Robinson was really not
being listened to by her doctor. There was a one-way conversation
going on there, and really, we cannot assume
what was going on. She had…wasn’t her health
care needs being met. In our program, we opened up
the discussion afterwards with prompts like, “This story
had a lot of key messages; tell me how this made you feel.” Wow, that opened up a lot of
discussion in our program. We didn’t tell people
what was going on. We later opened up some
discussion with, “How do you think
Mrs. Robinson felt?” And later some things
such as, “What do you think happened next in the story
with Mrs. Robinson?” Allowing the participants
the opportunity to share their feelings, their comments, then to talk about
the character, the patient–doctor relationship,
was very important. Many identified with the
character and expressed their own feelings of inadequacy
when it came to talking about health care providers. The discussion guide provided
talking points and open-ended discussion questions,
making it a useful tool for both experienced or
inexperienced facilitators. Following the discussions,
we had participants work together in small
groups to explore and practice talking
with your doctor. Later in the program, Alexis
will share with you an exercise to take with you, because
practicing the stepwise process was an effective way
to enhance the participants’ skills and increase
their confidence. We did a lot of role playing,
and in role playing—here you see one of the participants…two of
our participants actually doing a role play where they were
acting out the…a part of two sisters, one the
nagger and the other one the overwhelmed patient. By acting out these kinds of
situations in a nonthreatening third-person characters, they
were often able to talk about situations and develop
action plans. By practicing these action
plans, they could later develop their own sets of action plans. This is another picture of
them actually learning to take action plans and
incorporate them into their own active
living styles. Several participants created
their own New Beginning line dance from the
resources we gave them. There was a CD, New Beginning
CD, that they developed their own line dance and taught
to the others in the group. This was real empowerment in
action, and it was lots of fun. As an educator, I learned a
lot, and I began to see that they were beginning… they
were beginning to support and encourage each other. After one of the breakout
sessions, a member of the group was
practicing healthier Thanksgiving meal plans, and one
of them was overheard saying that she was going to explain
to her family that this year Thanksgiving was going to have
some new traditions for health. They were beginning to practice
that change talk and how were they were going to
talk to their families. As an educator, I
have a new beginning. Every day is a chance for me
to transform my interactions to an empowerment model. My job is never to tell people
what to do but to help them become more confident
in living with diabetes. I promise I will never show
another slide of a pancreas to a group of people living with
diabetes when they can learn so much more from Sorcy, Calvin,
Mrs. Robinson, and each other. At the end of each session,
we would give them a small clip from the NDEP
HealthSense website. It was very inspired
by the people. And I learned that New
Beginning outreach program— the people there
help to inspire me. Every day, I am still inspired
and honored by the people that I work with. Maya Angelou said, that
people may forget what you did, but they will never
forget how you made them feel. We all need to move toward a
new model and a new beginning. Alexis is going to talk a little
bit about a mini-lesson. Thanks, Peg. I just wanted to let everyone
know that for participating in today’s webinar, you will
receive the New Beginnings Mini-Lesson on Partnering
with Your Diabetes Care Team. This is straight from the New
Beginnings discussion guide, but we’ve adapted it into a
short, 10-minute lesson that you can incorporate
into whatever kinds of education you’re doing. It’s based on the
video from NDEP, Partnering with Your
Diabetes Care Team, which is appropriate
for all audiences. And it has some discussions
and some exercises, short exercises that people can do,
as well as some handouts, and those will be included in the
mini-lesson that you get after the webinar…after
today’s webinar. And as a bonus, you will also
get infographics that you can use to promote or print out
posters or handouts to promote patient–provider communication,
and those will be available in English and in Spanish. New Beginnings is not available
in Spanish, but we have made that infographic and those
patient handouts available in both English and Spanish. And I think we’ll
give it back to Janet. Thank you both, Alexis and Peg,
for your presentations. And I just want to just take
a little, some time…again, if you have
additional questions, please do present
them in the chat box. I think we answered a couple
of questions already—about the audiences that New Beginnings
is geared to—but I have one that’s from Robin, —and I guess
you all can decide who wants to answer these questions— Robin says, “Is the
New Beginnings Guide available to…for educators?” Yes, it is available. The…the New Beginnings
discussion guide is available on our website, and we will provide
the link to that in the…in the e-mail that you receive
after the webinar. OK. And then Leah Anne
Miyagawa again is asking, “Did all your participants
speak English?” This is Peg. Yes, in my situation in the
program that we had, yes. In the Pittsburgh area,
all of the participants in our program did speak English. OK. Anybody else want to
answer that question? Well, I just want to add that a
lot of materials are in Spanish, and the other thing that
I wanted to mention—I think this is really important—is,
you know, we use the word “educator” a lot in
throughout, you know, all of our presentations,
and yes, this is all, you know, a user-friendly program
that educators can use, but also want to, you know, remember
to think about all of you community workers that are out
there, working with folks in the community, and when we talk
about, you know, making sure that folks are supported
and continue to have ongoing support for education. I mean all of
these programs are, I think, created
in your interest. And so I just wanted to make
that clarification that I think these programs are available
and should be used by all of us who are providing services
to people with diabetes. OK. Thank you. We have another question from
Hannah Parks, and I think this is a great question: “If
you had only one session with the patient, i.e., no promise
that they’d come back for another education visit, what
kind of activities would you incorporate in a 45-minute,
one-on-one session?” So, I guess that you’re
asking me since I’m the CDE. Yes. After looking as if I were using
the whole New Beginnings program—and New Beginnings is
not DSME, so it doesn’t really necessarily meet that—I
would probably base it on what the patient is looking for. So, I would listen very
carefully to what the patient needed, but I would say probably
the one that says, you know, if the patient is demonstrating
some diabetes distress, I would use the program
that talks about stress. If it’s a new patient and
they’re looking for the basic, you know, the ABCs of what
is diabetes, that’s a really good segment on, you know, what
is diabetes, living well with diabetes, and the ABCs that
comes from the NDEP, you know, the four things you need to
manage diabetes, so a lot of those resources
are there to help. But the one about, you know,
developing the support network and how to talk to your doctor
and developing that, it was… it was actually
invaluable. So, if I had to pick one, I
would listen to the patient to see what their need is, and
I would individualize that to whatever the
specific need was. OK. Thank you very much, Peg. Next question is from Ann
Currens, and I think that we may…Ann Currens…I think
we may have answered this one: “Are there videos available?” So, the videos are…there are
links to all of the videos. There are also some audio
podcasts and some print stories available as well. All of the videos are in
the public domain, so you can feel free to show them. And they are all
online, and you’ll find the links to those online. “The Debilitator” is a
privately produced film. That’s the only one that’s not
available online, and there’s information about how to
get that video in the New Beginnings discussion guide,
which you can get that directly from the filmmaker and
your…you have permission to use that for education—not
just for New Beginnings, but any kind of education
program you’re having. The New Beginnings discussion
guide is only available as a download from our website, and
if you have problems, we know some people have bandwidth
problems downloading, so just shoot me an e-mail if you
have those kinds of problems, because we can either provide
all of the materials on a disk or we can provide a
printout for you, but we can’t do that for
everyone, so that’s just for people who have trouble…have
Internet connection problems. OK. Alexis, it sounds as though
you answered the question about the hard copy for New
Beginnings just now, right? Yes. That it’s only available
for download, right. OK. Thank you. Betsy Rodriguez is asking, “How
is behavior change measured?” Well, I’ll say for specific
for New Beginnings, there are behavioral objectives in each
module that you can use to measure behavior change, but
Linda and Peg, you can talk about your own experience
measuring behavior change. Yes, and I…this is…I guess
an answer with New Beginnings, but may be broader. I think there are a lot of great
validated measures that are really quick and easy to use. One of the ones that we use,
because I really believe that we need to empower patients,
is the empowerment form, the short form, and it’s just a
few questions, and it’s really helped our educators
guide them to see how they have empowered patients. Another great measure is
the Diabetes Distress Scale. You know, people are so burdened
with all the complex things they need to do, so
that’s another measure that I think is very useful. And there’s also some
self-care measures. And I think if you Google any
of those—the empowerment short form; the Diabetes
Distress Scale; or any of the self-care measures,
there’s pediatric and adult ones—I think that…I
happen to think that using validated measures is very,
very important, because if you collect that
information, you know, it really helps to determine
how your patients are doing and how effective you
are at your job. Thank you, Linda. I have…I think we have time
for a couple more questions. We have a question from Theresa
Cumberland: “Is the New…” Sorry, let me go back…I’m
sorry, I made…yes, Theresa Cumberland, “Is the New
Beginnings program designed for group sessions or
individual visits?” It’s designed for group
sessions, but people have adapted it for individual or
very small group sessions. So, it is really designed to be
flexible and to be adapted to whatever situation that
you find yourself in. OK. Thank you, Alexis. Danny Sarbot asks, “Are you
planning on getting these materials for this program
in Spanish in the future?” Yes. We are looking at adapting
New Beginnings right now for Hispanic/Latino, American
Indian, and rural communities, and we’ve also had requests
for Asian/Pacific Islander. So, I think everybody would
like their own version of New Beginnings, and so what we’d
like to do is just in addition to collecting new
story…stories that reflect the culture, but also
adjust some of the specific psychosocial and cultural issues
around emotional well-being in those…in those communities,
so, it’s a process, but yes, that is underway. That is, I can’t give you a date
for when that will be available, but we will let you
know when they are. OK. And then I think we have our
last question, which is from Kelly Coughlin, which is,
“Is there material being developed for East
African communities?” Wow! That’s a great question. No, we haven’t had a
request for East African. I think, you know, one of the
things to think about is how do we help people adapt the
guide, how do we help people collect stories and make
the questions relevant to the communities in
which they work. And so, maybe in addition to
different cultural adaptations, there is a need for, OK, how
you go out and collect your own stories to help support
not just New Beginnings, but any kind of diabetes
education, prevention, or self-management
education you’re doing. So, we will make a note of
that question because that’s a really…that’s
a great question. I’m sorry. I’m going to pull up
this one last question. I thought it was a
pretty good one, which is, “Do you…” and I think this
is…will be the last question, “Do you do a traveling road
show and bring this information to groups who may
be interested?” I wish I did. (Laughter) I’ll
get you some dancers, Alexis. (Laughter) Like the New
Beginnings line dance and… Yes, I’ll get you some… …that go out on the road. Unfortunately, we’re not able
to travel and provide training, but if you contact us, we can
discuss what options are available to provide additional
training on New Beginnings. So, we can’t always do in-person
training but contact us, because we can talk about what
options are available. OK. And is that, I’m
sorry that question came from Karen Christopherson. And what I’d like to say
is…thank you very much to all our presenters today
for the time and for answering all the questions. I invite everyone to go to
visit the newly redesigned NDEP website at and to check the many resources that
could help you in your diabetes education, prevention,
and control classes. Feel free to Linda…to e-mail
Linda, Alexis, or Peg, and they’ll be more than happy,
Margaret Thearle, they’ll be more than happy to answer
any questions you may have. Don’t forget that continuing
education credits will be provided through the CDC
training and continuing education online system. A handout will be provided once
we close this webinar, with specific instructions
on how to obtain CEUs or a certificate of completion. For those who joined
our webinar today, you’ll also receive a New
Beginnings Mini-Lesson, with patient handouts in
English and Spanish. We hope that you use
this lesson on your patient–provider
communications. And once again, I want to thank
you, everyone, and good-bye. (Music)

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