Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community.

A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/behaviorists, registered nurses, and registered dietitians; and a pharmacist.

The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. The committee convened on 31 March 2006 and 9 September 2006, and the Standards were approved 25 March 2007.

Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.

Before the review of the individual Standards, the Task Force identified overriding principles based on existing evidence that would …

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National Standards for Diabetes Self-Management Education

Purpose and Scope. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. Important Findings. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. Major Conclusions. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment ...

Powerlessness, Empowerment, and Health: Implications for Health Promotion Programs

CAROLÉ MENSING, RN, MA, CDE (TASK FORCE CHAIR) JACKIE BOUCHER, MS, RD, LD, CDE MARJORIE CYPRESS, MS, C-ANP, CDE KATIE WEINGER, EDD, RN KATHRYN MULCAHY, MSN, RN, CDE PATRICIA BARTA, RN, MPH, CDE GWEN HOSEY, MS, ARNP, CDE WENDY KOPHER, RN, C, CDE, HTP ANDREA LASICHAK, MS, RD, CDE BETTY LAMB, RN, MSN MAVOURNEEN MANGAN, RN, MS, ANP, C, CDE JAN NORMAN, RD, CDE JON TANJA, BS, MS, RPH LINDA YAUK, MS, RD, LD, CDE KIMBERLYDAWN WISDOM, MD, MS CYNTHIA ADAMS, PHD

Hardly a family in America has been untouched by mental illness. As many as one third of American adults will suffer a diagnosable mental disorder sometime in their life, and 20 percent have a mental disorder at any given time. Although research on the causes and treatment of mental disorders remains vitally important—and indeed major advances are leading to better lives for increasing numbers of people—much greater effort than ever before needs to be directed to prevention. The Senate Appropriations Committee of the U.S. Congress believed that a strategic approach to the prevention of mental disorders was warranted. The Congress mandated the National Institute of Mental Health to enter into an agreement with the Institute of Medicine (IOM) to prepare an integrated report of current research with policy-oriented and detailed long-term recommendations for a prevention research agenda. The specific tasks of the IOM committee, as negotiated with NIMH and the co-funding agencies, were as follows: • Review the status of current research on the prevention of mental illness and problem behaviors and on the promotion of mental health throughout the life span. This should include an understanding of available research knowledge, research priorities, and research opportunities in the prevention research area. • Review the existing federal presence in the prevention of mental disorders and the promotion of mental health, spanning the continuum from research to policy and services. • Provide recommendations on federal policies and programs of ABSTRACT xi Ab ou t th is P D F fil e: T hi s ne w d ig ita l r ep re se nt at io n of t he o rig in al w or k ha s be en r ec om po se d fro m X M L fil es c re at ed f ro m t he o rig in al p ap er b oo k, n ot f ro m t he or ig in al ty pe se tti ng fi le s. P ag e br ea ks a re tr ue to th e or ig in al ; l in e le ng th s, w or d br ea ks , h ea di ng s ty le s, a nd o th er t y pe se tti ng -s pe ci fic fo rm at tin g, h ow ev er , c an no t b e re ta in ed , a nd s om e ty po gr ap hi c er ro rs m ay h av e be en a cc id en t a lly in se rte d. P le as e us e th e pr in t v er si on o f t hi s pu bl ic at io n as th e au th or ita tiv e ve rs io n fo r a ttr ib ut io n.

Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research

The prevailing emphasis in health education is on understanding and changing life-style choices and individual health behaviors related to health status. Although such approaches are appropriate for some health problems, they often ignore the association between increased morbidity and mortality and social, structural, and physical factors in the environment, such as inadequate housing, poor sanitation, unemployment, exposure to toxic chemicals, occupational stress, minority status, powerlessness or alienation, and the lack of supportive interpersonal relationships. A conceptual model of the stress process incorporates the relationships among these environmental factors, powerlessness (or conversely empowerment), social support, and health status. The concept of empowerment has been examined in diverse academic disciplines and professional fields. However, there is still a lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. The purpose of this article is to address these issues as they relate to the concept of community empowerment. It provides a definition of community empowerment that includes individual, organizational, and community levels of analysis; describes how empowerment fits within a broader conceptual model of stress and its relationship to health status; and examines a series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The article concludes with broad guidelines for and barriers to a community empowerment approach for health education practice.

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Health Education and Community Empowerment: Conceptualizing and Measuring Perceptions of Individual, Organizational, and Community Control

THE HEALTH status of blacks, other minorities, and the poor remains unconscionably low when contrasted with that of white Americans. This disparity is not new but is an historical trend that can be seen across all categories of the leading causes of death and disease. In August 1985, the Report of the Secretary's Task Force on Black and Minority Health2 noted that minorities experienced approximately 60 000 "excess deaths" annually. Margaret Heckler, who was then the secretary of the US Department of Health and Human Services, emphasized that the disparity is "an affront both to our ideals and to the ongoing genius of American Medicine." The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. Since the 1985 report, blacks and Latinos, in particular, also have evidenced a disproportionately high rate

Community Empowerment as a Strategy for Health Promotion for Black and Other Minority Populations

The community organization and development process is not new and has its roots in social action ideology from the 1960s. The difference between the 1960s and the 1990s is in bringing together of target community consumers with representatives of private and public sector resources (with consumers in the majority), to form a community coalition board. This community coalition board must make policy decisions. Combining these community organizers and development techniques with the mission of health promotion is a viable methodology for addressing the needs of medically underserved and unserved communities. The approach is a multifactorial one, as illustrated in Figure 1. The Health Promotion Resource Center at Morehouse School of Medicine seeks to combine the ideology of community organization and development with culturally sensitive and linguistically appropriate health promotion curriculum materials and intervention strategies. Within the HPRC lies the Statewide Coordinating Center for Georgia which has been funded by the Henry J. Kaiser Family Foundation. Its mandate is to assist minority and poor communities in Georgia in developing community-based health promotion initiatives which address the areas of cancer, cardiovascular disease, adolescent pregnancy, substance abuse, and violence and unintentional injury. Our strategy in carrying out this mandate is the community organization and development model described in this article.

Ngina Lythcott

Papers

Community Empowerment as a Strategy for Health Promotion for Black and Other Minority Populations

Community organization and development for health promotion within an urban black community: a conceptual model.