XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

An Ecological Perspective on Health Promotion Programs

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

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Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Building Leadership Effectiveness This program encourages leaders to develop practices that transform values into action, vision into realities, obstacles into innovations, and risks into rewards. Participants will be introduced to the five practices of exemplary leadership: modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart Coaching & Communicating for Performance Coaching & Communicating for Performance is a highly interactive program that will give supervisors and managers the opportunity to build skills that will enable them to share expectations and set objectives for employees, provide constructive feedback, more effectively engage in learning conversations, and coaching opportunities. Skillful Conflict Management for Leaders As a leader, it is important to understand conflict and be effective at conflict management because the way conflict is resolved becomes an integral component of our university’s culture. This series of conflict management sessions help leaders learn and put into practice effective strategies for managing conflict.

기독교 사역과 Leadership

Bandura's theory of self-efficacy has been applied in many areas of health education including smoking cessation, pain control, eating problems, cardiac rehabilitation, and adherence to regimens. Consequently, self-efficacy has emerged as an important concept with which health educators should be familiar. Self-efficacy refers to one's belief in the ability to do a specific behavior. Self-efficacy is a principle connection between knowledge and action since the belief that one can do a behavior usually occurs before one actually attempts the behavior. Self-efficacy also affects the choice of behavior, settings in which behaviors are performed, and the amount of effort and persistence to be spent on performance of a specific task. This article will examine self-efficacy theory, describe sources of self-efficacy, and present applications of self-efficacy theory.

Self-efficacy and health education.

Community coalitions for health promotion: summary and further reflections

Community health promotion relies heavily on coalitions to address a multitude of public health issues In spite of their widespread use, there have been very few studies of coalitions at various stages of coalition development The purpose of this study was to identify factors that facilitated or impeded coalition effectiveness in the implementation stage of coalition development The research design was a multiple case study with cross-case comparisons Each of the 10 local North Carolina Project ASSIST coalitions constituted a case Data collection included: semi-structured interviews, observation, document review, and surveys of members and staff Some of the major factors that facilitated implementation included: the ability of the coalition to provide its own vision, staff with the skills and time to work with the coalition, frequent and productive communication, cohesion or a sense of belonging on the coalition, and complexity of the coalition structure during the intervention phase Barriers to effective implementation included: staff turnover and staff lacking community organization skills, dependence on the state-level staff during the planning phase and lack of member input into the action plan Conflict contributed to staff turnover, reluctance to conduct certain activities and difficulty in recruiting members, all of which had implications for implementation

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A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina

This quasi-experimental study assessed impact of factors associated with classroom implementation of health curricula by North Carolina teachers. School representatives selected and implemented one of three tobacco prevention curricula — Project SMART, Growing Healthy, or the Teenage Health Teaching Modules — in either sixth or seventh grades. Prior to implementation, experimental teachers and administrators received extensive curricula training. Implementation data were collected through teacher completed checksheets and classroom observations for two time periods — initial implementation (n = 69) and maintained implementation (n = 136). While training was associated significantly with whether teachers implemented a curriculum (p < .05), other factors also were important. Variables outside of teachers' direct control, such as supportive administrators, context in which health instruction is taught, and turbulence, affected quantity and quality of curricular implementation.

Teachers' Use of Health Curricula: Implementation of Growing Healthy, Project SMART, and the Teenage Health Teaching Modules

Purpose. To examine the effects of 10 youth developmental assets on adolescent tobacco use. Design. Survey of a randomly selected sample using in-home interviewing methodology. Setting. Inner-city areas of two midsized Midwestern cities. Subjects. The researchers studied 1,350 teen-parent pairs. Measures. Demographic information, adolescent self-reported tobacco use, eight developmental asset Likert scales, and two one-item developmental asset measures. Results. The response rate was 51%. Logistic regression results indicate that youth who possess nine of 10 developmental assets examined are significantly less likely to report tobacco use than youth with low levels of assets. Adjusting for youth age, race, gender, parental income and education, and family structure, significant odds ratios include the following: nonparental adult role model, 2.09 (95% confidence interval [CI] = 1.45, 3.02); peer role models, 2.48 (95% CI = 1.87, 3.29); family communication, 1.73 (95% CI = 1.29, 2.31); use of time...

Kenneth R. McLeroy

Papers

Self-efficacy and health education.

Community coalitions for health promotion: summary and further reflections

A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina

Teachers' Use of Health Curricula: Implementation of Growing Healthy, Project SMART, and the Teenage Health Teaching Modules

Adolescent Tobacco Use: The Protective Effects of Developmental Assets