The Science of Diabetes Self-Management and Care2023, Vol. 49(4) 324 –325© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106231169695journals.sagepub.com/home/tde
Although I was always drawn to patient education and was director of a patient-centered behavioral goal-setting nursing research project in the 1970s, my journey with diabetes education did not begin in earnest until 1983 when I attended my first annual meeting of the American Association of Diabetes Educators (AADE). The numbers were small, but the energy and dedication was contagious. I knew I was home.
One of the major activities that year was the adoption of Standards for Diabetes Patient Education. This was the first step in defining quality diabetes education, its importance, and our essential role. Starting in 1995, each revision has begun with a thorough review of the latest clinical, psychosocial, behavioral, and educational research. This ensures that people with diabetes (PWD) receive evidenced-based knowledge, skills, strategies, and ongoing support. Since that time, the development of Program Recognition and Accreditation, strong Position Statements, and publication of Consensus Papers1 with other organizations have exponentially added to our reputation, outreach, and significance. We make a difference.
While the early Standards told us what to teach, they were less helpful in knowing how to teach. Many educators believed their job was to improve compliance/adherence. A great deal of time was spent giving lectures and showing slides and models of the pancreas and red blood cells made out of L’eggs cartons. The messages were, “Don’t worry, it’s easy to manage diabetes” and “You should . . . and here is how you should change your life to do it.” But we learned that most PWD did not “just do it.”
About this time, my professional partner, Bob Anderson, and I began discussing the need to create collaborative relationships with PWD and integrate the clinical, behavioral, and emotional (eg, burden, distress) aspects of selfmanagement during every interaction. Our conversations led us to the person-centered philosophy of patient empowerment.2 In the accompanying article, we defined it as “the discovery and development of one’s inherent capacity to be to be responsible for one’s own life.”2 [Click this link to access article: https://journals.sagepub.com/doi/10.1177/014572179101700108] Because empowerment was different than the traditional goal of compliance/adherence, it was controversial. It also meant that we had to do things differently and make changes in our relationship with PWD and our role.3 Some of our colleagues struggled (and still do), some thanked us because it gave a name to their preferred approach, and others viewed it as a positive paradigm shift for the profession from compliance to collaboration.
Since then, we have learned that empowerment-based interventions improve metabolic, clinical, psychological, and behavioral outcomes among PWD in different counties and health systems, multiple ethnic and racial groups, and peer-led ongoing support. We have also learned that empowerment-based educational strategies are practical and can be incorporated into routine clinical interactions, group and individual educational sessions, and programs.
Empowerment-based diabetes self-management education and support (DSMES) is designed to prepare PWD to take on the responsibility of self-management, cope with the emotional burden of diabetes, and learn to make both informed and wise decisions and evaluate their results. Educational methods and strategies include selfdiscovery learning, self-determined goal setting, shared decision-making, creating equal partnerships, and using person-centered communication and nonstigmatizing language.4 There are no predetermined lectures or silos of content, but all needed information is provided. Much of the self-discovery and problem-based learning is derived from the personal behavioral experiments PWD create at each session.5,6 We use the I-SMART framework because it focuses on the personal “why” (I = importance and decision-making) rather than just the “how” (SMART).5 We also use the Michigan 5 M’s Framework for Self-Management and Decision-Making5,6 to integrate all aspects (eg, psychosocial, behavioral, and clinical) into each session and content area, as an overall framework for the program, and to help PWD make and evaluate their self-management decisions. And it works.
The Association of Diabetes Care & Education Specialists (ADCES) has changed a great deal since my early years. With every discovery, we have grown, become more person-centered and collaborative, and more effective. What has not changed is our passion for our patients, colleagues, and profession. We are Specialists, and we still make a difference.
Ms Funnell is a research scientist emerita in the Department of Learning Health Sciences at the University of Michigan Medical School. She is a pioneer in patient empowerment and has served as an investigator in 25 funded educational and behavioral research projects, primarily in diverse communities. Ms Funnell has also been a leader in developing and implementing evidence-based standards for patient education in national and international organizations and served as the first nurse chair of the National Diabetes Education Program. Ms Funnell is a Fellow of AADE (FAADE) Academy and the American Academy of Nurses (FAAN).
None reported.
Martha Mitchell Funnell https://orcid.org/0000-0003-2561-4087
From Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, Michigan (Ms Funnell).
Corresponding Author:Martha Mitchell Funnell, Department of Learning Health Sciences, University of Michigan, Michigan Medicine, 1700 Morton Ave, Ann Arbor, MI 48104, USA.Email: mfunnell@umich.edu
