As patients with diabetes have to take care of their condition outside of a hospital environment, they need to learn how to participate in their health management. Self-management practices that include treatment adherence, monitoring sugar values, and maintaining diet and exercise plans help to enhance life quality and health outcomes of the patients without additional expenses on care in treatment centers. Nevertheless, the term self-management does not entirely reflect the approach, as it fails to include all the stakeholders. Ideally, the patients do not need to manage their health by themselves but receive significant support from family, public health professionals, and self-management educators.
The Roles of Stakeholders in Diabetic Self-Management
Self-management of diabetic care outside of hospitals positively influences patients’ lives, eliminating stress and costs related to in-patient care. However, the best outcomes are achieved when the patients’ health is not managed by themselves only, but also includes many stakeholders who provide assistance and education for the patients. Dao et al. (2019, p. 176) explore the effect of self-management practices in Australia and attempt to answer why “recommended self-management behaviors were not routinely practiced by all.” Among the identified factors, health literacy, motivation, significant others, patient-provider relationship, affordability of care, and self-management resources were described as the most essential (Dao et al., 2019). That is why the term self-management does not sound valid, as the health outcomes depend on the variety of factors and stakeholders who support patients in their treatment and decision-making.
Family and friends can significantly facilitate diabetic self-management of patients assisting with food preparation and establishing the atmosphere of support and motivation. As Dao et al. (2019) claim, significant others mostly do not create barriers, but positively influence the adherence and efficiency of treatment and care. That is why they should participate in educational programs that focus on self-management practices, especially when it concerns those family members who are responsible for food preparation and dietary control. Pamungkas, Chamroonsawasdi, and Vatanasomboon (2017, p. 62) provide evidence for the efficiency of family support in “healthy diet, increased perceived support, higher self-efficacy, improved psychological wellbeing and better glycemic control level of blood pressure.” Healthcare providers are also significant stakeholders in the decision-making and self-management of the patients. The quality of patient-provider communication impacts the understanding of treatment processes and enhances patients’ self-efficacy.
Factors Influencing Patients’ Self-Efficacy
Self-efficacy among patients with diabetes can be defined as their belief in the ability to manage their healthcare needs effectively. This perceived belief has a direct impact on health outcomes in the case of self-management of chronic diseases. According to Abubakari et al. (2016, p. 2), an increase in self-efficacy can “enhance behavior change and improve adherence to chronic disease self-management recommendations.” Although self-efficacy describes the individual ability of patients in managing their health, it depends on several factors, including the role of outside stakeholders. Boger et al. (2015) claim that health professionals and family members can influence the health literacy and mental health of the patients, which, in turn, facilitate self-efficacy. Thus, self-efficacy, as an inherently patient-related factor of self-management influence, also depends on the impact of other stakeholders.
Although diabetic self-management implies patient-centered care, it cannot be stated that they should take health-related decisions alone, as efficient self-management relies on the support of multiple stakeholders. Family, health providers, and educators can facilitate this process by increasing health literacy and motivation, improving mental health, and assisting with essential routines. Even if they do not participate directly, they can enhance patients’ self-efficacy and improve health outcomes in this way. Therefore, self-management can be described as supported outpatient care that involves many stakeholders apart from the patient’s “self.”
Is Self-Management Beneficial to Positive Health Outcomes in Diabetes Prevention or Management?
Various self-management models are often used in chronic disease care to provide outpatient treatment and prevention. Given the absence of acute conditions, such an approach can improve patients’ quality of life, allowing them to live regular lives and stay at home instead of hospitals. Self-management helps to minimize expenses on hospital readmission, reduce stress levels, and prevent health complications. Nevertheless, insufficient health literacy and limited support can hinder the achievement of positive outcomes, signifying the need for a comprehensive approach to self-management. However, when properly managed, such practices can improve health outcomes with minimum stress levels and maximum cost efficiency.
The Efficiency of Self-Management Regarding Health Outcomes
Since people with diabetes require continuous daily routines regarding their treatment, dietary management, and physical exercises, self-management is a convenient alternative to in-patient care. Nevertheless, it should be discussed, whether this model has a positive effect on health outcomes not only the treatment convenience. With insufficient health literacy and without the necessary support, people with diabetes have higher risks of medication and diet non-adherence that results in health complications and further readmission. That is why education programs are used to “navigate these decisions and activities and have been shown to improve health outcomes” (Powers et al., 2015, p. 1323). Scholars claim that the programs used to educate patients with diabetes have the potential to eliminate risks of non-adherence and facilitate the positive effect of self-management (Powers et al., 2015). When adequately coordinated, the model can bring a lasting positive impact on patients’ health by improving their quality of life.
Application of Chronic Care Model for Diabetic Self-Management
The Chronic Care Model (CCM) is generally applied in the case of chronic diseases without high risks of severe complications to allow patients to live their life in a familiar environment. This model offers evidence-based approaches that entail the participation of public health specialists, the community, patient education providers, and self-management support. The main benefit of the method is that it accounts for all the possible stakeholders that have an influence on health outcomes. According to Chmiel et al. (2017), CCM applied for diabetes care can ensure long-term results in improving patients’ health. Therefore, the model has the potential to advance diabetes management and prevention because of its comprehensive approach that fosters cooperation between patients and specialists.
The Role of Patient Educators in Self-Management Practice
As health literacy and motivation are essential factors influencing diabetic self-management, the position of educators who bring the necessary information to the patients is of utmost importance. As King et al. (2017, p. 2) claim, the modern patient education system in Australia has significantly transformed, going from nurse-provided in-hospital services to “interdisciplinary collaboration and role flexibility… enhancing efficiency, effectiveness, and economy in health care delivery.” Currently, these professionals represent such work settings as hospitals (38%), community health services (28%), and private practices (ADEA, 2016). According to the Australian Diabetes Educators Association (ADEA, 2015, p. 9), certified educators “integrate diabetes self-management education with clinical care as part of a therapeutic intervention to promote physical, social, spiritual and psychological wellbeing.” Thus, they pursue such goals as knowledge development, individual risk evaluation, cultural factors exploration, and maximization of health outcomes.
Patient self-management of diabetes is not only a convenient approach but also an efficient treatment model that facilitates positive health outcomes with minimum costs. With the implementation of such comprehensive models as CCM, the risks of non-adherence can be minimized while patients receive support from multiple stakeholders. Moreover, sufficient education increases patients’ literacy and allows them to engage in decisions about their health. While educators guide patients in eliminating negative factors and accounting for individual risks, self-management of diabetes remains a valid and efficient framework.
Abubakari, A.-R., et al. (2016) ‘Socio-demographic and clinical predictors of self-management among people with poorly controlled type 1 and type 2 diabetes: the role of illness perceptions and self-efficacy’, Journal of Diabetes Research, 2016, pp. 1-12.
Australian Diabetes Educators Association (ADEA) (2015). Role and scope of practice for credentialled diabetes educators in Australia. Web.
Australian Diabetes Educator’s Association (ADEA) (2016). Workforce in diabetes education. Web.
Boger, E. et al. (2015) ‘Self-management and self-management support outcomes: a systematic review and mixed research synthesis of stakeholder views’, Plos One, 10(7), pp. 1-25.
Chmiel, C. et al. (2017) ‘Four-year long-term follow-up of diabetes patients after implementation of the Chronic Care Model in primary care: a cross-sectional study’, Swiss Medical Weekly, 147, w14522.
Dao, J. et al. (2019) ‘Factors influencing self-management in patients with type 2 diabetes in general practice: a qualitative study’, Australian Journal of Primary Health, 25, pp. 176-184.
King, O. et al. (2017) ‘Diabetes educator role boundaries in Australia: a documentary analysis’, Journal of Foot and Ankle Research, 1(10), pp.1-11.
Pamungkas, R. A., Chamroonsawasdi, K., and Vatanasomboon, P. (2017) ‘A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients’, Behavioral Sciences, 7(3), p. 62.
Powers, M. A. et al. (2015) ‘Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics’, Journal of the Academy of Nutrition and Dietetics, 115(8), pp. 1323–1334.