Four Theories and a Philosophy: Self-Management Education for Individuals Newly Diagnosed With Type 2 Diabetes

  1. T. Chas Skinner, PhD,
  2. Sue Cradock, RGN, DipN, MSc,
  3. Francesca Arundel, RGN, BSc and
  4. William Graham

    Many reviews of educational interventions for people with diabetes have criticized the lack of reported theory in the development or descriptions of these programs.1,2 Yet these reviews seem to ignore a fundamentally more important omission in the self-management education and behavior change literature—a lack of reporting of the projects’ philosophies of care. A program that is designed to persuade or motivate individuals with diabetes to do what health care professionals think they should do, for example, is substantially different from a program built on the philosophy of supporting individuals to achieve their own goals for diabetes management. This issue of philosophy is of fundamental importance because it influences the theories that may be used, the educators’ attitudes (cognitive, affective, and behavioral), and the content and style of any educational material and interaction.

    This article reports on the development of a series of self-management education workshops for individuals newly diagnosed with type 2 diabetes. It focuses on how different theories from health psychology have been used to guide the development of the workshops and how these theories have been implemented in delivering the workshops.


    The Health District of Portsmouth, U.K., has a population of 560,000, an estimated 17,000–18,000 of whom have diabetes (3% prevalence). To develop diabetes services for this population, the Diabetes Service Advisory Group, which represents all of the primary and secondary care organizations involved in delivering diabetes services locally, held a workshop facilitated by the local Health Authority (governing body for the Health District). Workshop participants, including health care professionals, commissioners of health services, and people with diabetes, were asked to set priorities for the delivery of better health care for people with diabetes in the locality. “Patient education at diagnosis” topped the resulting list of priorities.

    One of the primary care groups, which served …

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