• Fresh Views

    A recap of solution-focused sessions from IDF Congress 2019

    Busan Gamcheon Culture Village (부산 감천문화마을)

    “A mind that is stretched by a new experience can never go back to its old dimensions.” – Oliver Wendell Holmes

    Hi, this is Deb writing today. I just recently returned from the International Diabetes Federation Congress, in Busan, Korea. A few of our readers made it to this conference, along with many more friends from the diabetes community who presented interesting sessions that we @AFreshPOVforYou thought you might appreciate.

    Living with Diabetes Stream

    My main reason for attending was to present on a panel discussing #LanguageMatters as part of the Living with Diabetes Stream, a series of sessions that focus on life with diabetes where many people living with diabetes discuss their strengths and challenges and share real world experiences. It was a great opportunity to share lessons learned over the past several years about how empowering, person-first, strengths-based language can not only improve healthcare communication, but also health outcomes. I co-chaired the panel with Renza Scibilia, from Australia, one of the early adopters the #LanguageMatters movement. There were three speakers, each with a slightly different focus. 

    First, Shinomi Takahashi,  a nurse and PhD candidate from Japan, presented on the meaning of the word “diabetes” in different languages. It was fascinating to learn that in Japanese, diabetes, tou-nyou-byou (糖尿病) means “sugar-urine disease”, and many people feel this adds to the stigma of living with diabetes. There was a movement in Japan to change the names of type 1 and type 2 diabetes to describe the physiological differences of the conditions, similar to U.S. discussions. However, as several mentioned in the session – the differentiation between types actually leads to more stigma associated with type 2 diabetes.

    Next, I spoke on the Value of Language Guidelines. The key takeaway was that the use of guidelines helps to change the practice of healthcare. When educating healthcare professionals (HCPs) about the impact of language on engagement in care AND health outcomes, HCPs start to listen. If only all medical, nursing, dietetics and other health profession education programs began each year with a review of the use of strengths-based, person-first language, we’d all be in a better place. The more I learn, write, and speak about incorporating a solution-focused approach into diabetes care and education, the more I realize that this approach makes the use of strengths-based language so easy and natural. So, if we can help HCPs incorporate this approach into practice, we can help change the language at the same time! As always, I ended my presentation with the film co-designed by people living with diabetes and HCPs,  “Changing the Conversation”, that continues to resonate with audiences who engage with people with diabetes. (I think it was shown at least three times during the conference!)

    Deb presenting at the Diabetes Spotlight stage

    The final speaker, Elizabeth Snouffer, Editor for DiabetesVoice.org, presented information around the messaging and advertising that has wrongly portrayed diabetes in the eyes of the public. She shared how creating a culture of fear, victim blaming, and stereotyping does nothing but fuel the myths and misconceptions. What was really fascinating was the focus on how advocacy organizations and other consumer focused groups actually contribute to the stigmatizing language. Some of the images she shared were unbelievable (You can see some of those here on Twitter). She concluded with examples of successful campaigns that have made a difference in changing the conversation around diabetes. 

    Digital Health

    I also sat on a digital health panel, Technology; The future is now, with a line-up of amazing individuals representing the spectrum of the digital health:

    • Kyle J. Rose (Healthcare Enthusiast and Innovator), a newly elected Vice President for IDF Global, and previously with mySugr, chaired the panel 
    • I represented the perspective of the HCP, diabetes care and education specialist, and the realm of digital coaching 
    • Renza Scibilia (Type 1 Diabetes and Consumer Voice at Diabetes Australia), as she proclaimed, was the “most important person on the panel, the person living with diabetes” (and of course we all agreed) 
    • Manny Hernandez (Head of Community, Livongo) represented the health technology industry
    • David Staehler (VP, Eli Lilly, Global Brand Development), represented the pharmaceutical industry
    • Dr. Mahmood Kazemi (VP Global Medical and Scientific Affairs, Abbott Diabetes), represented the medical device industry, and 
    • Dr. Jane Speight (Foundation Director, The Australian Centre for Behavioural Research in Diabetes), represented the psychological side of living with diabetes and technology 

    Some of the key takeaways from the session were: 

    • Technology is not one-size-fits-all; tools need to be individualized.
    • Both population level data analysis and individual data interpretation are needed to change health outcomes.
    • There is a burden associated with technology and data for both the person living with diabetes and the HCP.
    • And from my perspective: There is often too much focus on data that is “out of range” taking a problem-focused approach, and not enough implementation of a solution-focused approach. 
    Deb, Manny Hernandez, Jane Speight and Renza Scibilia getting ready for the panel

    Diabetes Distress

    I also chaired a session on Diabetes Distress. Dr. Jane Speight, from Australia, gave a brilliant talk about the benefits of peer support for diabetes distress. Although not much research has focused on this issue, she shared a few research studies that showed significant and meaningful improvement in diabetes distress, especially in a group setting. Attending in-person group meetings can be challenging for people, but there is promise that online peer support groups can have the same impact as in person. She suggests that while more research is needed, peer support is beneficial.

    Living with Diabetes Award Lecture

    Manny Hernandez showing his now famous blue circle slide representing the time a person actually spends self-managing diabetes

    One of the highlights for me was the Living with Diabetes award lecture by Manny Hernandez.  Manny shared his journey with diabetes beginning with initially being misdiagnosed with type 2 diabetes. Fortunately, Manny had a primary care doctor who knew when he “was out of options” and referred Manny to an endocrinologist, who finally diagnosed him with LADA. For years, Manny was not connected with other people living with diabetes. Then one day he attended a group with other people with diabetes, and learned more in that one hour than he had in the previous four years. This experience led him to develop the tudiabetes.org online peer support community (and EsTuDiabetes.org in Spanish), and eventually The Diabetes Hands Foundation (DHF). The peer support experienced from these communities has impacted so many lives, so people no longer feel alone. I was on the Board of DHF when it closed with Manny’s transition  to work in industry (Manny was caring for his mother living with Alzheimers, so he needed to leave the nonprofit world and now works for Livongo). Yet, Manny had the foresight to ask Beyond Type One to take over the DHF communities and they continue to thrive. (Excitingly, I’m now working on a research study and engaged again with the EsTuDiabetes.org community….more to come on that next year!). The love for Manny in the diabetes community is strong and was evident during his presentation. I felt privileged to be there in person when he received this well-deserved honor.

    Manny’s diabetes “Tribe” after his award lecture (Photo courtesy of Boudewijn Bertsch)

    There were many other sessions I wanted to listen to, but they conflicted with my sessions. They included Riva Greenberg’s presentation on the Flourishing Approach (we wrote about it here), and a presentation on #TalkaboutComplications with Renza Scibilia and The Grumpy Pumper, which addressed language used when talking about diabetes complications, and the stigma and bias those discussions often lead to.

    The more we support using strengths-based language, the more we realize how closely connected language is to a solution-focused approach. Focusing on strengths and what’s working well generates solution-talk and a uniquely different experience between clients and HCPs. 

    Exciting advantages of speaking at conferences are the opportunities to learn something new,  meet new people, see new sights, and of course see fresh views. I’ve broadened my diabetes colleague network and made new friends on this trip, while reconnecting with old friends. I  saw many interesting sites in Busan and ended my conference by spending a few sightseeing days in Seoul before heading home. I even got to connect with my daughter’s freshman year college roommate who lives outside of Seoul. Hopefully I’ll make it to IDF 2021 in Bangkok, Thailand!

    Sunset over Busan

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Reducing Risk

    You are braver than you believe, and stronger than you seem, and smarter than you think. – Christopher Robin

    National Diabetes Month is almost over, what informative and interesting activities were you engaged with this year?  

    Taking a solution-focused approach to diabetes self care

    As we near the end of the month, we are also finishing our 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. This series is focusing on “flipping” the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. Last week we shared about taking a solution-focused approach to Problem Solving. And the prior weeks we focused on Taking Medications here, Monitoring blood glucose here, Healthy Eating  here, Being Active here, and Healthy Coping here. This week, we are talking about Reducing Risks 

    When looking at this picture above of the friendly neighborhood kitty balancing precariously across the covered porch rails, it reminds us of life with diabetes… trying to stay in balance never knowing when the bottom may fall out.  

    AADE7 Self-Care Behavior #7: Reducing Risks

    Taking care diabetes today can help people feel good today AND in the future. When blood glucose is in range, one is more likely to:

    • have more energy, both physical and emotional
    • be less tired and thirsty
    • pass urine less often
    • heal better and
    • have fewer skin or bladder infections

    Many say they are their “best self” when their blood glucose is in range. And managing diabetes TODAY means there will also be less chance of having health issues caused by diabetes over time. The important words there are “over time.” Taking care of diabetes now will help reduce the risk of heart attacks, stroke, damage to kidneys and nerves, and loss of vision. But It’s not just about the diabetes, it’s about supporting those with diabetes in living their best life! 

    A journey of a thousand miles begins with a single step. (Chinese Proverb)  Just one step.

    We want to support and guide our clients toward actionable steps they can take now to live well with diabetes and help reduce the risk or delay issues down the road. Then, the key is replicating that small step over and over again to build momentum and actually feel progress. Small steps add up. You may be surprised by the great impact these small, yet simple things can have! 

    The language we use when talking about diabetes complications is important to think about. When we use words like “prevent” as opposed to “reducing risk or delay progression” we imply that ALL complications CAN be prevented. Science tells us that this isn’t always true. Some people have genetic predispositions to either be “protected” from complications or to be at a higher risk. Healthcare providers can add to the stigma, shame and blame associated with diabetes when they don’t acknowledge the fact that some people will end up with complications……just because. We don’t want people to shy away from discussing health concerns, so let’s use our #LanguageMatters voice when we #TalkaboutComplications. That’s what The Grumpy Pumper (AKA Chris Aldred) has been doing this past year. Traveling around the globe, including a stop at #AADE19,  speaking openly and frankly about living with a complication from diabetes. You can read his blog here.  As Grumpy says, “Even with the best of care, people can get complications.” (from Diabetes Connections Podcast) So let’s use a solution-focused approach when talking with people with diabetes complications instead of rehashing any problems.

    When working with clients instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this:  By no means is smoking a simple habit to change. What can you do more of that may help you smoke less? Or what needs to happen to help you make changes?

    Instead of this: You need to stop smoking. Smoking is bad news with diabetes.

    Try this: How can you fit in an extra visit to see your eye doctor during national diabetes month?

    Instead of this: You are behind on getting your eye and dental exams.

    Try this: On a scale of 0 to 10, with 0 being never and 10 being always, how often are you able to get an annual flu shot to help prevent illnesses?

    Instead of this:  You haven’t gotten your flu shot.

    Three follow-on questions to help you not only feel  better today, but to help prevent problems down the road:

    • What is one action you can take to reduce your risk? Work closely with your healthcare team to identify the best strategies for you to help manage them and prevent progression to live your best life.
    • What can you do NOW, right this second…to make life better now, as well as down the road.
    • What single change can you make over the next week?

    And consider how people in your life can help. Loved ones, family, and friends can be close allies in your diabetes management. (last week we discussed VIPs, you can read it here)

    We can encourage clients to keep taking those small steps each day. Consistency and routine build on each other. Small steps add up. If people do the best that they can do…then they can say at the end of the day, I did the best I could, and that’s a good feeling.

    We hope you’ve enjoyed our series and that we’ve made you think before engaging with clients. And if you’re a person living with diabetes, we hope our choices resonate with you. Each week we’ve challenged you to try some flips into your conversations. Let us know what impact they have had. Please reach out to us to share feedback.  Let’s continue to join together  to raise awareness of all issues that can improve living with diabetes.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou


  • Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Taking Medications

    Self-care is never a selfish act – it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves, but for the many others whose lives we touch. -― Parker Palmer 

    Big Ben in London, England 

    @AFreshPOVforYou is one-year old!

    Happy birthday to us @AFreshPOVforYou! Our blog is officially one-year old, 56 posts later! 

    Over the last year we have focused on Possibilities, Opportunities and creating a Vision (POV) for the future by taking a solution-focused approach to life with diabetes. We’ve been excited to share our work and learnings by speaking at the AADE19 Annual Meeting, helping diabetes care and education specialists learn how to incorporate a solution-focused approach into their practice. We also shared our Twitter research findings at the European Association for the Study of Diabetes conference in Barcelona, Spain. And we’ve conducted a survey, focus groups, and have a few papers in process. It’s been a great year and we’re excited to see where this next year leads us!

    And it’s now national diabetes month 

    We purposely launched this blog right before #WorldDiabetesDay last year, to kick off our new adventure. And here we are again. What are you doing for diabetes month? Do you have an event or an idea you’d like to share with us or our readers? Please let us know in the comments. We’ll be adding in some diabetes month discussions throughout November, along with sharing insights about using solution-focused approach to self-care behaviors.

    Taking a solution-focused approach to diabetes self care

    This  week is week 5 of our 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. This series is focusing on “flipping” the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. Have you tried any “flips” in the past 4 weeks? Please let us know if you have, and what your experience was. 

    Last week we shared about taking a solution-focused approach to Monitoring blood glucose – you can read it here.  And the weeks prior we focused on Healthy Eating  here, Being Active here, and Healthy Coping here.. This week, we are talking about taking medications. 

    AADE7 Self-Care Behavior #5: Taking Medications

    While taking medication of some type is often required somewhere in the journey with type 2 diabetes, it’s not always simple to engage in this self-care practice. We hear that routinely from clients we work with. Here are 3 challenges that frequently bubble up…

    1- Remembering. No matter what one’s age, remembering to take medication can be a challenge at one time or another. After all, life happens and can derail even the best intentions. In our experience, missing medication doses can also be linked to the dosing frequency, side effects, or diabetes distress. When it comes to remembering to take medication, solution-focused strategies to consider include, using a medication reminder app, using a pill box, pill packs, keeping the medication in view as a reminder (if it doesn’t require refrigeration), marking a calendar when a dose is taken, and setting an alarm on a smartphone or clock. (The mention of a clock, reminded us of Big Ben in London, so that’s our fresh view for today!)              

    2 – Stigma. With type 2 diabetes, there is often stigma associated with taking medicine. There is a false sense that people “should” be able to manage diabetes through healthy eating, being active and losing weight. But we know that is not always reality. Given that diabetes has a genetic link and is a progressive condition, things change over time. What works today, might not work next month or next year. So talking about diabetes medicine using a positive, solution-focused approach can help build a trusting relationship and a therapeutic alliance in which to discuss medicine choices and barriers while using a shared-decision making approach.  

    3 – Cost/Access. We must also be cognizant of the cost of medicine when considering options. Although there are some incredible, effective new medications that impact the patho-physiology of diabetes, these new drugs often come with a high price tag. And they may not be included on insurance formularies. And the cost of insulin is beyond crazy. The American Diabetes Association has a website to help people navigate this complex issue and provide a list of resources. Unless we have open conversations, we may not know that people are not taking their medicine because they are not able to afford it. How can we say they are “non-compliant” or “non-adherent” when this is the case?  We need to change the language we use in diabetes, especially around medication taking. The #LanguageMatters conversation is essential when talking about medications.

    When working with clients instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this: Diabetes is a progressive condition. It’s common for people to need more medicine over time. Can we talk about the benefits of adding insulin?

    Instead of this: You’ve failed oral medicine, you need to take insulin.

    Try this: What challenges do you have when taking your medicine?

    Instead of this: You’re not compliant with your medicine.

    Try this: How many days each week do you take your medication?

    Instead of this:  How often do you forget to take your medication?

    We challenge you each week to try some flips into your conversations and let us know what impact they have. Let’s join together throughout the month of November to raise awareness of all issues that can improve living with diabetes.

    Join us next week as we discuss a solution focused-approach to the self-care behavior around problem-solving.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou


  • Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Healthy Eating

    Problem talk creates problems, Solution talk creates solutions. – Steve de Shazer

    Tasty, healthy grilled mussels in garlic and lemon

    We are excited to launch into a 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. As you probably know, the AADE7 is a framework for organizing diabetes self-management education and support and for identifying key areas that may require behavioral changes to manage diabetes.  The 7 categories are:

    For those of you that follow our blog, you know that we are passionate about flipping the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. We are advocates for the use of person-first, empowering language when speaking with and in reference to people with diabetes. #LanguageMatters in diabetes care and education; problem centered talk can make speaking about and managing diabetes more challenging.

    Each of the next seven weeks, we will focus on one of the above self-care behaviors and provide 3 practical illustrations of how to flip the conversation around it to solution-focused talk.

    AADE7 Self Care Behavior #1: Healthy Eating 

    “What can I eat?” is the #1 question asked by people with diabetes when they are diagnosed. Without a doubt it can be a confusing, challenging, and sensitive ongoing area of diabetes management. 

    Often the healthy eating discussion focuses on foods to avoid and “what went wrong” when blood glucose was out of range. The conversation continues with discussion on how to prevent that from happening again. This approach to eating can be painful and result in feelings of blame and shame. A solution-focused approach changes the dynamics of the conversation.  It helps flip the focus to what is working well and building upon existing strengths.

    Instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this: I noticed that you are drinking sweet tea or soda only three times a week now instead of every day. How have you been able to do that? 

    Instead of this: Are you still drinking sweet tea and soda? 

    Try this: I hear you saying that you’d like to lose 20 more pounds. I’m noticing you are down 5 pounds since we last met. I’m really proud of you. What do you think helped you lose those 5 pounds? 

    Instead of this: I hear you saying that you’d like to 20 more pounds. I see you’ve only lost 5 pounds. What have you been eating?

    Try this: We’ve been talking about trying to work in more non starchy vegetables at dinner to help fill you up without raising your blood glucose. How many days a week do you think it’s reasonable to start with? On a scale of 0-10, where 0 is not all and 10 is I can definitely do this, where would you rate yourself? 

    Instead of this: We’ve talked about trying to work in more non starchy vegetables to help fill you up. I want you to eat one at lunch and dinner every day. 

    Be a think partner

    During a solution focused conversation, the diabetes care and education specialist acts as the “think partner” in developing solutions by asking questions and helping the person with diabetes to use their own personal strengths to create solutions that work for them. 

    When you meet again, here are 3 follow-up questions to try:

    • What’s been better since our last session?
    • What skills did you draw upon to make changes?
    • What do you know about yourself that lets you know you can achieve what you want?

    We’ll challenge you each week to try incorporating some flips into your conversations and let us know what impact they have.

    Join us next week as we discuss a solution focused-approach to Being Active!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    Seeing with new eyes: Perceptions of life with diabetes

    The real voyage of discovery consists not in seeking new landscapes, but in having new eyes. – Marcel Proust 

    A view of La Sagrada Familia through an arch on the roof of Casa Mila in Barcelona, Spain

    #EASD2019 is a wrap! Hi this is Deb this week. I represented @AFreshPOVforYou at the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD) conference in Barcelona where I was excited to share the results of our study (more about that below). I learned much at the meeting, connected with friends and colleagues, and met Twitter followers in person for the first time! I also had time to do a little sightseeing and take in the food and culture of Barcelona!

    Front entry of the EASD 2019 meeting, Barcelona

    Our abstract, Perceptions of life with diabetes revealed through a solution focused brief therapy exercise via Twitter, was presented on the final day of the conference in a very large room. Often many people leave for home the last day of the conference so I feared the room would be empty, but it was not! Given that this was the only session addressing the psychology of diabetes, there was a great crowd. The presentation focused on the use of the Miracle Question, a solution-focused tool, to help people overcome challenges by using “solution talk” rather than “problem talk.” We wrote about it in our blog post about our AADE presentation here and here describing our World Diabetes Day 2018 #DSMA Twitter chat.

    I try to start all of my presentations with a slide reminding the audience (or sometimes educating them for the first time) that #LanguageMatters when speaking with or about people with diabetes. You can read our past blog posts related to this here and here.

    #LanguageMatters slide

    I asked for a show of hands to see how many in the room were familiar with the Miracle Question approach. I only saw one hand raised. Since this was a 15-minute research presentation, it was hard to cover a lot of the background, so the focus was on the study outcomes. It was exciting to see lots of Tweets about the presentation and that the concept of a solution-focused approach was being spread across the Twitterverse. You can read the full abstract here

    We have submitted the complete data to be published (fingers crossed that happens soon!). However, in brief, when we employed the Miracle Question approach during a Twitter chat there were five themes that evolved.  That means that these were the most common threads, thoughts, comments that were expressed by those who participated in the chat. The themes were: more of living life; laughter and humor; self-compassion; resilience; and support.  

    Deb at the podium presentation

    There were several questions at the end of the session and many people came up to talk about the approach. In fact, several researchers shared with me about their research and how they could see incorporating a solution-focused approach into their research study.  It was very exciting to see the interest in this tool.

    Most of the comments and questions were positive. Interestingly, one questioned the value of having people “think less” about their diabetes, and worried that diabetes management would be hurt. I responded by saying that Dana Lewis (creator of Open APS) might disagree. When I heard her speak earlier in the conference she indicated that with her Open APS system, she thinks less about diabetes, including not having to bolus when she eats carbs.The theme of “more of living life” meant different things for different people.  The Grumpy Pumper (Chris Aldred) commented, “For me, the issue isn’t how often I think about my diabetes, it’s the type of thoughts. Looping hasn’t made me think less, but my thoughts are more positive because I’m seeing the results I want.”  This was a great perspective. The overarching message was that they wanted to focus on the positive aspects of life.

    It’s important to acknowledge that people engaged in a diabetes Twitter chat are likely very engaged in their diabetes management. There was a question if the process would still be successful in others. We agree that we have the same questions and hope to conduct additional research in this area in the future.  

    We also had a Diabetes Online Community (DOC) advocate @Blue_sugar_cube reach out and ask how she and the DOC could get involved with our work. That was exciting! As well as seeing a few new subscribers to our blog!

    And lastly, a big thanks to @WeRateTalks on Twitter who gave our talk an 11/10!  Wow! We were honored!

    We’ll be seeing some of these diabetes friends in Busan, South Korea for the International Diabetes Federation Congress where Deb will be speaking on two panels, one on #LanguageMatters and one on digital health. 

    Kellie, Karen, Grumpy, Renza, Deb and Donna at the end of our presentation

    By sharing a solution-focused approach to diabetes management with a worldwide audience we hoped to inspire people to think differently and consider incorporating a solution- focused approach in their practice.

    We began this post with the quote, The real voyage of discovery consists not in seeking new landscapes, but in having new eyes by Marcel Proust . We’d like to encourage health care professionals to “have new eyes” when they think about diabetes management, and be open to new tools and solutions. 

    If you’re a researcher and would like us to consult on a future research grant, please reach out – we’d love to chat!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com. 

  • Fresh Views

    Highlights from American Diabetes Association Scientific Sessions (Part 1): Focus on Behavioral Health

    “Wellness is the complete integration of body, mind and spirit – the realization that everything we do, think, feel and believe has an effect on our state of well-being.” ~ Greg Anderson

    Tami, Mike, Deb and Mark enjoying the “Fresh Views” in Marseilles, France

    We’ve just returned from a relaxing vacation in the South of France where we imprinted enough “fresh views” to last us quite a while! But we are quickly back to work, with the first stop post vacation at The American Diabetes Association Scientific Sessions in San Francisco. A Fresh POV for You attended some inspiring sessions, particularly those focused around behavioral health. (If you’ve been following our blog, you know that’s a special interest of ours.) We thought we’d share highlights from several that were particularly impactful.

    Highlight #1

    One of the most rewarding presentations was the Richard R. Rubin Award lecture, presented by Dr. Frank J. Snoek, PhD. The award recognizes an individual who has contributed to the science of the behavioral aspects of living with diabetes. Dr. Snoek’s talk  #DiabetesPsychologyMatters focused on the important connection between behavior change and mental health. As one of his slides depicted…they are two sides of the same coin!

    Dr. Snoek noted that one goal is to shift the burden of diabetes distress, so that higher distress can be moved down to moderate, and moderate moved down to low. He also indicated that a single high score on a distress scale does not mean that an individual needs professional help, or is in a maladaptive situation. Everyone with diabetes experiences diabetes distress at some point and at some level.

    Additionally, he discussed the correlation between mood and behavior, an area of significant interest to us at A Fresh POV for You. He described that when someone actually feels good, they are able to shift their priorities towards less pleasant activities that might help them achieve more long term goals. However, when someone has a low mood, they tend to seek short term rewards to help them feel better in the present.

    Overall he emphasized the need to enhance access to care and specifically called out what he described as “indirect interventions” –  including Diabetes Self Management Education and Support (DSMES), psycho-education as well as internet/mobile interventions. Specifically, he called for incorporating behavioral techniques along with existing pure “education” practices.

    Photo of Frank Snoek’s slide at ADA Scientific Sessions showing the indirect psychological support that can be provided by nurses, diabetes educators, etc.

    We believe that by incorporating Solution-Focused Brief Therapy (SFBT) techniques and counseling approaches, diabetes educators can address the needs of people living with diabetes, incorporating “two sides of the same coin”. Addressing both the self-management education and support needed for behavior change, while at the same time, addressing mental health concerns, such as diabetes distress. In essence, we can “fill the gap” that exists in access to psychological care. Overall this lecture solidified our efforts in moving this approach forward within the diabetes community.

    Highlight #2

    Another impactful session focused on complications associated with diabetes. The emotional toll of diabetes complications-What have we done for them lately.  The panel was moderated by Dr. Korey Hood, a behavioral scientist. Panelists included Chris Aldred (aka The Grumpy Pumper), Kerri Sparling (Six Until Me), Matthew Heywood, and Ina Mendoza. They spoke frankly and candidly about their experiences living with diabetes complications. Managing diabetes is tiring enough, then add a complication, and it becomes so much more complex. Much of the discussion addressed the stigma associated with diabetes complications and how the panelists were/are often told that they “should have done better”. Ouch.  #LanguageMatters when talking about complications. Making people often feel “less than” when they have a complication.  Where is the compassion in care?

    One question from the audience was, “What can we do to make this better?” So, A Fresh POV for You posed an answer to consider….”How about incorporating a more solution-focused approach into practice?  With focus on the solutions and strengths an individual has to help move them forward, rather than focusing on past problems and trying to identify why they occurred.” We know that no matter how much effort goes into managing diabetes, sometimes people still get complications. We also referred to Adam Brown’s Book, Bright Spots and Landmines,, featured in one of our  April blog posts. Focusing on “bright spots” are similar to focusing on the “exceptions” or the things that are going well used in a solution-focused approach.  

    We look forward to sharing more of these concepts in our presentation at the American Diabetes Association Annual Meeting in Houston in August,  Applying the Miracle Question in Diabetes Care.. In fact, here we are finalizing our slides before the deadline while in Marseilles, France.

    What deadlines look like on vacation!

    Highlight #3

    Stigma was a theme common through many of the behavioral health sessions. As recipient of the Outstanding Educator in Diabetes Award, Virginia Valentine, shared a moving presentation, The most important thing we give to people is…Hope: Overcoming stigma in diabetes and obesity,. She explained that the stigma associated with diabetes causes blame and shame, and that “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of being loved or belonging.”-Brene Brown. She reminded the audience that “the only thing people with diabetes did wrong is when they picked their grandparents.”  She ended her presentation with a review of the language guidelines that foster person-first, strength based language.

    Highlight #4

    Finally, there was the session on #LanguageMatters- Strategies to Improve Communications in Diabetes Care. Jane K Dickinson, and Joe Solowiejczyk, both healthcare providers and people living with diabetes, gave their perspectives on the use of language. Notably, Jane was the lead author on the publication , The Use of Language in Diabetes Care and Education (we’ve written about #languageMatters in the past here). Then Kevin Joiner connected the dots between the stigma associated with language when engaging in a healthcare discussion. Finally, Dr. Jane Speight, lead author of the Australian Position Paper, A New Language for Diabetes, helped to identify strategies for healthcare providers to communicate more effectively with people living with diabetes. We were excited to see them show the Telly Award Winning #LanguageMatters video that was co-designed with the #DOC and released last year at the AADE meeting, Changing the Conversation.

    Deb watching the Changing the Conversation #LanguageMatters video at the #ADA2019 meeting (Photo credit Renza Scibilia)

    Check back July 10th as we share another big highlight from ADA Scientific Sessions,  discussion of the recently published “Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report”.

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  • Fresh Views

    Co-design: How we are engaging people living with diabetes in designing diabetes education services


    A new day dawning

    Please, let patients help improve healthcare. Let patients help steer our decisions, strategic and practical. Let patients help define what value in medicine is. –Dave deBronkart, Let Patients Help

    Imagine with us…… a square table. On one side sits the healthcare team. On the other sits their patient living with diabetes. The healthcare team has created a plan and program of great things for their patient that they think their patient needs…without once asking for any input or perspective of that patient – the one who actually lives with diabetes 24/7/365. What if instead, at that same table, everyone is sitting on the same side. The individual living with diabetes was included in the discussion and decision making from the very beginning. The plan and program was crafted around their input. That’s an illustration of co-design. And that is something we strongly believe in. What if relatable individualized solution-focused education services for people with diabetes were co-designed with people living with diabetes?

    What exactly is co-design?

    The Institute for Healthcare Improvement defines co-design in the following way: “Co-design involves the patients in the design process and works with them to understand their met and unmet needs…..This enables us to incorporate the patient perspective directly and immediately.”   In theory it doesn’t sound complicated, but it doesn’t seem to happen very often. The healthcare profession has a long history of the clinician being the “expert” and the patient being the one to “follow orders”. Often, programs and services are designed by the medical staff, independent of patient input. Some more evolved health systems are adding patient and family advisory councils to get feedback and input. However well meaning, they’re often not facilitated to the full potential.With co-design, everyone has an equal say in creating the solution. It is not spending time just getting feedback about programs you’ve already designed….it’s about including people in the decisions from the very beginning.  

    So instead of the healthcare team solving problems they think exist, co-design allows a multi-stakeholder team to first identify the problem that really exists and then develop solutions together. People living with diabetes know what’s worked for them and what hasn’t, and how they would create a program if they had the chance. This is truly a person centered approach to care.

    How has @AFreshPOVforYou been engaged in co-design?

    Supported by a three-year PCORI award, the Intercultural Diabetes Online Community Research Council, affectionately known as, iDOCr, was born (which Deb is a part of). The goal of PCORI is to help patients make more informed healthcare decisions by supporting research that compares the effectiveness of existing, known and proven treatments. All PCORI projects involve patients from the very beginning of every research study or community engagement project. With the iDOCr funding, a stakeholder group was created that represented researchers, clinicians, people working in industry, non-profit organizations and people affected by diabetes (people living with type 1 and type 2 diabetes and caregivers). Both English and Spanish-speaking individuals were included.Together, over the three-year award, this team developed a research question that was important to the group with the goal of eventually receiving funding to conduct the study. One of the main outcomes of this award was very interesting to us….although the majority of the iDOCr patient representatives lived with type 1 diabetes, the team decided to develop a research study focused on type 2 diabetes in the Hispanic community, because that is where they saw the need. This is the essence of co-design; preconceived ideas might have encouraged a completely different research question. The team is about to embark on the research study very soon, so stay tuned for more information. You can learn more about iDOCr via Facebook, Twitter and read the Blogs here.

    We also led the development of two videos to educate about the use of person first language in diabetes.  These 2 videos “Why Language Matters” and “Changing the Conversation” were written and produced using co-design principles. The background and supporting information was first taken from the 2017 paper, The Use of Language in Diabetes Care and Education jointly published by AADE and the ADA. We wanted to understand how language has directly impacted people living with diabetes by learning about real world experiences. We also wanted to learn from healthcare providers how they used empowering, person first language in their practices. So, we developed questions and asked the diabetes community to answer them. We were so overwhelmed with responses that we knew people really wanted to share their stories about why #LanguageMatters to them. From these stories we crafted the scripts for the two films and then we sent the scripts back out to the diabetes community to make sure we got it right. Finally, the videos were filmed with those same individuals, not actors, but people living in the diabetes community. The amazing, talented and Telly award winning creative director from Mytonomy, Mr. Kevin Kuchar created videos that we are so proud of and really reflect the true emotion that language can create and why the language we use in healthcare has a direct impact on outcomes and well being. Read our November, 2018 blog Language can change your POV!

    How are we using co-design now?

    Currently, we are using co-design to help us create diabetes services that resonate with people living with diabetes. Our efforts began with a #DSMA Twitter Chat with the diabetes online community. Questions for the group focused around how diabetes education could bring them joy (read our blog to learn about this discussion). From this information we developed a survey to dive deeper and learn more. One finding from the survey was that most people with diabetes are not familiar with the concept of co-design, which told us that it’s not happening much in the healthcare space where diabetes is being managed. We’d like to change this practice and share with others how its done!  Our next step is to hold a focus group. Each step along the way, we are learning new things.

    We’ll be excited to share out focus group outcomes and learnings later this year. Stay tuned!

    As e-patient Dave said, we want to “let patients help” us move diabetes education services forward in partnership with the real experts, those living with diabetes 24/7/365.

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  • Fresh Views

    Being human first: Perspectives around optimizing healthcare interactions


    Tami and Deb enjoying fresh views in Chicago, finding freedom and joy in life.
    T

    Of course different people fulfill different functions in this world. It cannot be otherwise. As far as intellectual or physical abilities are concerned – knowledge, skills, talents, and energy levels – human beings differ widely. What really matters is not what function you fulfill in this world, but whether you identify with your function to such an extent that it takes you over and becomes a role that you play. When you play roles, you are unconscious.“   – Eckhart Tolle

    Deb’s been listening to an Oprah’s Book Club book on Audible, Eckhart Tolle A New Earth: Awakening to Your Life’s Purpose. While Deb has found the book deep, and a challenging “read”, she’s found that it creates an opportunity to take an introspective look at the way we engage in the world. Tolle believes everyone can find “the freedom and joy of life” if they live in the present moment.

    Deb has also been listening to Oprah’s weekly Super Soul Conversations Podcast to review each chapter of the book, typically while taking her daily walk (and it’s helping a lot to understand and internalize the concepts). During a recent podcast there was discussion between Oprah and Tolle about roles people play and how roles inhibit thinking.  In applying some of Tolle’s principles to our mission and vision here @AFreshPOVforYOU, there was an “a ha” moment for Deb around how the #languagematters movement in healthcare needs to expand to include not just the words we use, but also how we implement person first language. (check out our November blog on why language matters here)  To really put the person (not the “patient”) first, there needs to be a “person” on both sides of the interaction for true person centered care.

    One section of Oprah’s weekly podcast addressed healthcare and how when a healthcare professional “plays the role of healthcare professional”, he or she may become “unconscious” of the fact he or she is a human person while embracing their “healthcare role”. And, that the “patient” across from them is also a person. Something vital is then missing. And as a result, the person (“patient) may end up feeling disconnected and dismissed.

    The discussion brought to mind a recent #DSMA Twitter chat that @AFreshPOVforYou joined a couple of weeks ago. One question asked during the chat was: “How can healthcare practitioners facilitate more empowering or effective communication with patients or vise versa?”  One enlightened participant, the incredible behavioral and data scientist Dr. Chandra Osborn replied, “Be a human first – a practitioner second.”  

    Her reply really struck a chord, and aligns with the closing words in Tolle’s quote above, “When you play roles, you are unconscious.“ Let’s repeat that…..”When you play roles, you are unconscious”. How can there be empowering or effective communication if people are not “present” and if they are “unconscious”?

    Along those lines, We @AFreshPOVforYOU have experienced this first hand.

    Deb’s experience…

    Deb recalls a visit with her daughter to the pediatrician where they never once made eye contact. The doctor typed on the computer the whole time, asking impersonal questions and fulfilling her role. They did not feel like they were part of the conversation.

    Tami’s experience…

    Tami remembers a similar scenario while sitting alongside her mom at hospital discharge following her mom’s knee surgery. The healthcare team was talking all “around” both of them, talking to each other, asking questions, giving a multitude of instructions, rarely looking at them or expressing interest in their point of view or concerns. They did not feel like they were part of the conversation either.

    We’ve heard many similar stories from people with diabetes – how at times the relationship with their healthcare provider was not ideal. Some have stated they cancelled an appointment because they didn’t want to be scolded for an A1C value that was higher than expected. Or because their weight was up a few pounds.

    In traditional healthcare people with diabetes are expected to play the role of patient and clinicians play the role of doctor, nurse, dietitian etc.  Yet this type of engagement does not promote healthy communications and relationships. As Tolle recounts, “Authentic human interactions become impossible when you lose yourself in a role.”

    We’ve experienced being on both sides of this equation.  As diabetes educators, we are always striving to improve, but we are not perfect. We’ve made our share of mistakes, but we’ve grown and learned from them. Deb recalls one client she saw years ago that was very frustrated with her because she was following the “assigned content” for the appointment per the prescribed healthcare provider orders, and at the end of the visit the client said, “we didn’t have time for any of my questions!”  That meeting really left an impact on her, she was playing the “role” of a diabetes educator and she never made that mistake again. Fast forward to a more recent experience when she received a call from a healthcare provider who referred his patient to her.  The doctor said, “I’m not quite sure what you did, but Mr. Jones is never satisfied with anything  or anyone, but he could not stop talking about how his appointment with you was the best diabetes visit he’s ever had.”  You know what she did? She started by asking him about his family and recent vacation, and then asked what was going well with his diabetes management?  She was being a human first and he was treated like a person.

    If you follow our blog, you know that we are advocates of solution focused therapy. In the context of solution focused therapy, the client/person with diabetes is viewed as the expert and the most important element is the “therapeutic alliance” between the client and the practitioner.  The relationship is the key to being able to work together. And to build a relationship it requires being present, being conscious of one’s own behaviors, use of language, and body language which all tell a story. We believe it’s critical to enter healthcare exchanges as a human first- not playing a role – with each party recognizing their part in the conversation/interaction as valuable.

    Our goal, through incorporating principles of solutions focused therapy and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.  As Eckhart Tolle says, we need to “become conscious of being conscious.”  We need to work as a team, be present in all of our interactions and most of all be human.

    In closing, we leave you with a few thoughts on what you can do when you engage in a healthcare interaction.

    If you are a healthcare provider:

    1. Be human first
    2. Check your ego at the door
    3. Appreciate that the person in front of you is as an expert on their condition
    4. Listen carefully before speaking
    5. When possible, sit on the same side of the table
    6. Understand the burden associated with living with a chronic condition

    If you are a person living with a chronic condition:

    1. Be human first
    2. Actively participate in your medical appointments and your self-management to the best of your ability
    3. Work in partnership with your care team
    4. Be honest about your capabilities

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  • Fresh Views

    Language can change your POV

    As National Diabetes Month comes to a close, we’d like to share this blog post written for the Society for Participatory Medicine blog post published November 2, 2018.  

    The language used in healthcare has such a significant impact on how a person living with diabetes FEELS about living with diabetes and how they trust and engage with healthcare professionals.

    If you already know us, you know we support the language movement and encourage everyone to think about language in a new and fresh way. When we drafted the scripts for the two #LanguageMatters videos (links on our web page on the lower right and in the blog post) that’s when we began to think about creating A Fresh POV for You because we knew there were more opportunities to impact the diabetes community in a new and positive way.

    Here are a few quick and easy suggestions, that while simple can be a game changer and help stop the blame, shame, stigma and judgement often associated with diabetes.

    • Instead of using words like adherence and compliance, focus on what the person is actually doing to manage their diabetes.  You can ask about when and how they are taking their medication, focusing on their strengths instead of judging behaviors.
    • Refrain from using language that implies the person living with diabetes is unmotivated or doesn’t care. Instead, recognize the time required to manage a chronic condition and appreciate the hard work they are doing every day.
    • Replace the word diabetic with person living with diabetes all of the time! (However, a person living with diabetes can choose the language that best suits them.)

    As we suggest in the blog mentioned earlier, language choice is a habit, and just like anything else, it takes a little practice to change behavior!  If you start to think about diabetes management from a solution focused approach you will naturally use language that is strengths based and action oriented, and not focused on blame. We can embrace a healthier way of talking about diabetes by changing perspectives on language and the impact it has on anyone living with diabetes. Let’s create fresh, new behaviors because #LanguageMatters!

     

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