What are the key drivers of long-term behaviour change in type 2 diabetes patients?
During the interesting panel discussion
at the Expert Forum on diabetes, we discussed behavioural psychology and how people can decide to change of their own volition. But what is even more difficult than changing someone's behaviour? To make sure this person sticks to the new behaviour! This was the focus of our discussion with Dr Jen Unwin: How do we ensure persistency of behaviours?
Over the last five years, Jen and her husband seem to have found an answer. In their local general practice, they have developed a sustainable low-carbohydrate diet
intervention for type 2 diabetes patients with great results. No new drug – just a focus on changing the way people eat. Jen explained the three key reasons
why this behaviour could persist long-term:
1. Person-centered: It's important that goals are connected to someone's personal values because this is where motivation comes from. Each person's desire is different - from one woman wanting to fit into a beautiful dress, or a grandpa wanting to play football with his grandson. Patients must be intrinsically motivated to change, and healthcare professionals should seek to understand their patients' goals.
2. Feedback: It is essential to give people frequent feedback about whatever is being measured – breathing more easily or losing weight. People are proud of what they achieve and the focus should be on their small, step-by-step improvements.
3. Support: This new way of eating may seem unusual for patients' families or communities. Patients may hear things like "It's your birthday; just one piece of cake won't kill you!" In order for patients to stick to new behaviours, they should receive support from their healthcare professional or their (online) community.
Jen has time to speak with her patients about their goals, albeit briefly. But how easy is it to find out people's goals when you don't have personal interaction? On diabetes.co.uk, you can find short videos of Jen talking about motivation and goals. People define their goals, enter them online and revise them along the way. Trust is key here – if you see your healthcare provider doing a certain thing, you are most probably going to trust that this is good for you as well. Therefore, Jen walks the talk, cooking healthy meals and giving ideas on healthy menus. Their message is rather simple: "You can eat this but not that". The sorts of food that people can eat are surprisingly delicious and satisfying: eggs and bacon instead of muesli for breakfast. Who would not switch? As an added bonus, even the cholesterol level of their patients improved. Jen confessed that a few people disappear from their program but then come back again because they felt better when being on the low carbohydrate diet. However, by falling back to their old habits, they inevitably put on weight or their blood sugar worsened so they often come back. Jen treats this situation as a "no-fault, no-shame" come-back.
Jen sees an increasing interest from other GP's regarding the key drivers of long-term behaviour change in type 2 diabetes patients, but the education of healthcare providers needs to improve before her methods can go mainstream. Jen's long-term research is currently being peer-reviewed and will be published soon. While her anecdotal evidence is interesting, I look forward to reading the publication that may give their results a higher validity.
Would you like to know more about what diabetes.co.uk does? Watch our interview with Charlotte and Arjun.
Category: Funding longer lives: Long-term care