IMPROVING PSYCHOSOCIAL MANAGEMENT OF DIABETES IN NOVA SCOTIA!

SEPTEMBER 2011

Welcome!

NEWSLETTER
Contact Us WWW.IMPROVINGDIABETESCARE.COM Abbie J. Lane Building 5909 Veterans' Memorial Lane 4th Floor, Suite 4060, Room 4055B Halifax, Nova Scotia B3H 2E2 Phone: (902) 473-3915 Fax: (902) 473-4873 Contributing Members
Holly Dempsey holly.dempsey@cdha.nshealth.ca Syble Woods sybled@hotmail.com

Who are we? The Behaviour Change Institute (BCI), founded by Dr. Michael Vallis, is a recent development within Capital Health to help improve behavioural management of chronic health conditions such as diabetes, pre-diabetes and cardiovascular disease. Under the umbrella of the BCI, Dr. Vallis is leading an ongoing research project to support lifestyle change and improved management of psychosocial issues in patients with these conditions.

Emphasis is being placed on better understanding health care professionals' experiences/opinions regarding: psychosocial issues in diabetes, mental health services, and formal training in self-management support. Hence, an Individual Diabetes Educator survey and a survey for mental health professionals were developed and administered. The Results are in! A special thank-you to those of you who participated in the surveys.

Upcoming Psychosocial Events

November 2011 Lunenburg / Bridgewater January 2012
Halifax February 2012 Cape Breton Psychosocial Workshops are being planned across the Province. All Diabetes educators and Mental Health Professional are invited. Currently we are at the planning and organizing stage. Stay tuned!

This project is funded by the Public Health of Canada, through the Canadian Diabetes Strategy.

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IMPROVING PSYCHOSOCIAL MANAGEMENT OF DIABETES IN NOVA SCOTIA! SEPTEMBER 2011

SURVEY RESULTS - SNAPSHOT

Our surveys were completed by 34 diabetes educators (16 nurses and 18 dietitians) and 48 mental health professionals across Nova Scotia. The following is a summary of the most salient results from the surveys. 1. Psychosocial issues are considered 'Extremely Important' in the management of Diabetes: 1 2 Not at all Important 3 4 5 6 7 Extremely Important Diabetes Educators AVG 6.9 Mental Health Professionals AVG 5.82

2. In providing clinical services to individuals with diabetes, how often psychosocial issues are encountered in their practice that, in their opinion, would lead to improved diabetes outcomes if addressed: 1 Never 2 3 4 Often 5 6 7 Diabetes Educators AVG 5.78

Daily

3. Top three psychological factors in management of diabetes according to diabetes educators who responded to our survey:

Motivation Condence / Self Ecacy Major Depressive Disorder

Top three psychological factors in management of diabetes according to mental health professionals who responded to our survey:

Motivation Behavioural Habit Health Beliefs

This project is funded by the Public Health of Canada, through the Canadian Diabetes Strategy.

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IMPROVING PSYCHOSOCIAL MANAGEMENT OF DIABETES IN NOVA SCOTIA! SEPTEMBER 2011

4. Percentage of Diabetes educators interested in formal training in techniques of self-management support:

100% 75% 50% 25% 0%

96.6%
More Training

3.1%
No Training

5. According to diabetes educators and mental health professionals who responded to our survey, these are the preferred training methods to incorporate formalized approaches to self-management support in their practice:

Workshops" Toolkits Both Workshops and Toolkits

This project is funded by the Public Health of Canada, through the Canadian Diabetes Strategy.

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IMPROVING PSYCHOSOCIAL MANAGEMENT OF DIABETES IN NOVA SCOTIA! SEPTEMBER 2011

MICHAEL CORNER"" S
As the healthcare system becomes more focused on chronic disease, secondary and primary prevention as well as health promotion, there is a shift from symptom management to behaviour management. As such, significant issues associated with adherence to medical treatment regimens and self-management are being identified. As the lens in healthcare shifts from the clinician let me tell you what you need to do..let me tell you what you need to know to the individual how can I support you in better managing your condition? the relevance of psychosocial issues becomes greater. When medical clinicians ask patients how they can help the patient, it commonly raises issues such as emotional distress, problems in relationships, stress and coping strategies. Mental health providers are extremely comfortable and capable of addressing these very same psychosocial issues, but they work with a very different population those with mental health disorders. So here is the divide. Within chronic disease management, psychosocial issues are being recognized as critical to manage. However those with the skills to support this management are occupied in other areas. Bridging this divide is important. Our project is designed to support both the healthcare provider working with diabetes and other chronic disease and the mental health provider who can support the management of psychosocial issues. To get this process started I will place this work in the context of two important issues. First, the quality of life versus the psychopathology model. Much of the work of the mental health provider occurs within the context of psychopathology, serious mental health problems that meet criteria based on the Diagnostic Manual of Mental Disorders. While many of those living with chronic disease meet criteria for a mental health disorder diagnosis, most do not. The typical person with chronic disease who is struggling in some way with psychosocial issues would be best seen as having impaired quality of life, or problems in living. Much of the distress experienced by these individuals is secondary to their condition. As such, psychosocial interventions tend to be more straightforward and require less resources than in a typical mental health practice. As an example, the mental health provider might not even need to be the one to implement the intervention. It might be competently implemented by the medical provider with support from the mental health provider.

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Second, given that the illness is dominant in the experience of the distress of the individual it is best that one begins to understand the emotional experience of the individual from a broad perspective. Assessing emotional distress within the mental health field involves assessment and differentiation of types of affect; depression, anxiety, anger, etc. The quality of life model is more general for instance, in assessing quality of life it is helpful to begin with an assessment of the general constructs of well-being and distress. A very quick and useful method of assessing distress amongst those with chronic disease is illustrated with the following tool: If diabetes were a weight that you carried around in a knapsack on your back, how heavy would it be? a 1 lb loaf of bread a 5 lb sack of potatoes a 50 lb iron anvil a 2 tonne truck

Beginning the conversation of distress with a question like this is very useful because it allows us to identify distress associated with the illness. If we identify that someone has significant psychosocial concerns that are unrelated to their illness then this is an indication that a straightforward referral to mental health services is in order. This is the existing model, one that is well developed and for which existing services are devoted. But should not be surprised if many if not most patients will identify significant illness-related distress. This is the area where we hope to help. In closing, we are hopeful that you will find our resource helpful and that you will provide us with feedback and guidance. We hope that over the next year we will craft this resource into something that is sustainable and that you will have a hand in creating. Michael PAGE 4

This project is funded by the Public Health of Canada, through the Canadian Diabetes Strategy.