American Diabetes Association Scientific Sessions
American Diabetes Association Scientific Sessions
Source/Disclosures
Source:

Polonsky WH. Tedious, tiresome and dull — an unrecognized problem that we can solve. Presented at: American Diabetes Association Scientific Sessions; June 12-16, 2020 (virtual meeting).


Disclosures: Polonsky reports he is a consultant for Abbott Diabetes Care, AstraZeneca, Dexcom, Insulet, Intarcia, Lilly Diabetes, Novo Nordisk, Onduo, Sanofi, Servier and Xeris.

June 14, 2020
4 min read
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‘Tedious, tiresome and dull’: Strategies to improve diabetes self-management education

Source/Disclosures
Source:

Polonsky WH. Tedious, tiresome and dull — an unrecognized problem that we can solve. Presented at: American Diabetes Association Scientific Sessions; June 12-16, 2020 (virtual meeting).


Disclosures: Polonsky reports he is a consultant for Abbott Diabetes Care, AstraZeneca, Dexcom, Insulet, Intarcia, Lilly Diabetes, Novo Nordisk, Onduo, Sanofi, Servier and Xeris.

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The dropout rate for participants in diabetes self-management education and support classes remains high, and diabetes care and education specialists must look in the mirror to make needed improvements, according to a speaker.

Adults with newly diagnosed type 2 diabetes are often never referred to diabetes education self-management education and support classes, William H. Polonsky, PhD, CDE, president of the Behavioral Diabetes Institute and associate clinical professor at the University of California, San Diego, said during the Outstanding Educator in Diabetes Award Lecture for the virtual American Diabetes Association Scientific Sessions. When they are referred and attend a class, they are overwhelmed with information in a “tedious, tiresome and dull” way that does not make room for questions and discussion about what really matters, he said.

Diabetes diet 2 2019
Source: Adobe Stock

“I ask you, as educators, to think about your own programs. Maybe it’s time to face the truth,” Polonsky said. “Problematic attrition is not happening because our programs are inconvenient, although that does have some role to play. To a much larger degree, the problem is us. Our programs are boring.”

William H. Polonsky

Many studies demonstrate that diabetes self-management education and support, or DSMES, makes a difference for people newly diagnosed with type 2 diabetes; however, few are referred and even fewer attend a DSMES program, Polonsky said. Few studies are done assessing why participants drop out of programs or are not referred in the first place, although anecdotal evidence suggests that some — including health care providers — do not believe the classes are worthwhile, Polonsky said.

“It is clear that, in the best case, less than 30% of patients referred ever make it,” Polonsky said. “Most people who do make it never make it through the whole program. They drop out early. The evidence on this is very limited, but we all know this is true.”

More than boredom

As diabetes care and education specialists, it could be easy to see the problem of poor attendance at DSMES classes as the fault of the participant, Polonsky said. Surveys conducted with people who stopped attending DSMES classes often cite convenience, which could lead specialists to think tweaking class times or locations will fix the problem, he said.

Convenience is an issue, but there is more to it, Polonsky said.

“When people say, I’m too busy to come back, to an extent what they are thinking is, ‘Your program is not that worthwhile,’” Polonsky said. “That is something we need to think about. It is polite to say you are too busy. People are voting with their feet.”

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Often, attendees drop out of DSMES programs for reasons beyond convenience or even boredom. Too many people do not feel engaged or interested, he said.

“Of all the educators I have met, we don’t mean to be boring, but we see that it happens,” he said. “It happens when educators feel pressured by their health care systems to deliver way too much information, when educators are fearful that too much interaction will make it difficult to deliver all the information, and when educators are concerned they won’t be able to answer participants’ questions.”

Strategies for improvement

Polonsky said diabetes care and education specialists can take several steps to improve DSMES for participants:

Cut down on content. Addressing participants’ concerns about their education is more important than explaining how each class of medications works, Polonsky said. The ability to estimate carbohydrates or read food labels — a focus in many programs —may be less important than helping participants identify one dietary change they might make, and understand why that change is meaningful, Polonsky said. “Most of our participants are just like us,” he said. “We’re not interested in learning what an HbA1c is, but we might be interested in learning what our HbA1c is and why that might be important. It’s a principle of psychology, most of our universe is about us. We need to appreciate that.”

Make programs personally meaningful. Programs should make room to talk about the “why bothers,” starting every class with a reminder and discussion about why participants are there, Polonsky said. On a white board, list participants’ questions and confusions about the subject at hand, for every class. “Every session should end with asking each person what they think about what they learned, and what they might now try or do differently,” he said.

Admit educators have a problem. Keep track of no-show and drop-out rates. Find and interview program dropouts and ask them what was missing for them. If the participant claims the class was inconvenient, ask more questions, Polonsky said. Brainstorm solutions to address the “boring” problem. “Imagine what we could really accomplish with an 8- to 10-hour DSME program if we had more free time?” Polonsky said. “We need to think about that and get much more innovative and creative.”

“The bottom line is this — let’s refuse to be boring,” Polonsky said. “We educators can be cool. We are often knowledgeable and innovative people. We don’t have to be straightjacketed by this belief that we have to be lecturing and powering through tons of facts to shove onto diabetes patients. Let’s transforms diabetes education to focus on what is really the key principle of education that can lead to successful behavior change, and that is this, as said by William Butler Yeats: ‘Education is not the filling of a pail, but the lighting of a fire.’”