Theoretical Background

When one thinks of the role of psychology in diabetes or other types of health care, the image that comes to mind is that of a patient discussing emotional difficulties with a therapist or counsellor in a mental health setting. This stereotype, based on a referral system for behavioural health care, was generally accurate for many years. Today, however, the face of psychology and behavioural science in diabetes is changing, spurred on by both the development of brief behavioural interventions and the information technology revolution1-3.

Both the range of issues addressed by psychology and the modalities of intervention have expanded significantly. Psychologists and other health professionals are increasingly involved in diabetes care. In some instances, they are part of multidisciplinary teams providing direct patient care in medical offices. In other cases, they supervise practice innovations, design computer-assisted intervention programmes or instruct other health professionals in behaviour change principles and strategies.

There is an important need for psychologists to be more involved in the diabetes care that takes place in medical offices, for three primary reasons. First, many patients will not or cannot avail themselves of psychological assistance offered via the traditional referral system. Patients frequently have many barriers to following through on referrals, including cost, lack of familiarity with behavioural science, convenience and time commitment required, and anticipated stigma associated with 'seeing a shrink'. Second, the quality of care provided for diabetes patients in most medical settings is substantially suboptimal4-6. Almost all population-based studies of the level of recommended 'best practices' received by patients have revealed much lower than desired rates of clinical services and screening measures4,5. The rates of preventive services, and especially lifestyle change interventions, are even lower5,6. Third, patient-centred, motivational interviewing, and patient activation/empowerment approaches have consistently been found to produce beneficial effects, yet such strategies are seldom employed in either primary care or specialty endocrinological settings. Thus, there is a compelling need and great opportunity for the application of behavioural science in medical office settings.

From a conceptual and social-environmental influence perspective7'8 the medical office setting occupies a strategic position in the 'pyramid of social-environmental influences' on patient self-management and decision-making processes (see Figure 6.1). As can be seen in Figure 6.1, health care system encounters fall midway between the more proximal influences, such as personal actions and family and friends, on the one hand, and more distal factors, such as community and media/policy influences, on the other. Because of this position and the enormous credibility accorded to physicians and other health care professions in our society, interventions in medical settings have great potential also to leverage the other levels of social-environmental factors.

Figure 6.1. Pyramid of psychosocial factors

The medical office setting also has much to recommend it, due to the frequent contact most diabetes patients have with their health care providers. On average, patients with diabetes see their doctor for several visits per year. This repeated, ongoing contact provides a potent context within which to work with patients to collaboratively set goals, develop strategies, collect information, provide feedback, and modify goals or set new ones1'9'10. Another important asset from a public health perspective is the availability of medical records, and the increasing prevalence of diabetes registries, which permit population-based disease management activities11.

To take advantage of these opportunities, however, psychologists will have to change how they do business1. In particular, they will need to adapt their assessment and intervention strategies to be compatible with, and to fit into, medical settings. In addition, they need to understand the world views and training of physicians (as well as nurses, dieticians and other health care professionals) and how these frequently differ from those to which psychologists have been acculturated in their own training and practice.

Delicious Diabetic Recipes

Delicious Diabetic Recipes

This brilliant guide will teach you how to cook all those delicious recipes for people who have diabetes.

Get My Free Ebook

Post a comment