Social cognitive theory and type ii diabetes education: A case study

Type II diabetes is one of Australia's six national health priority areas, and typically afflicts overweight adults who are over forty years of age. Although type II diabetes can be controlled through lifestyle modifications such as diet and exercise, many diabetic patients find these changes difficult to make, and to sustain.

Even when patients attend diabetes education programs which include medical information and skills training designed to facilitate changes in patient self-management behaviour, many fail to improve or control their condition.

Although the research literature has identified that health education programs which are based on Social Cognitive Theory (Bandura, 1997; 1986), and which are designed to increase participants' self-efficacy and outcome expectations, can produce changes in self-management behaviour - the research outcomes for group diabetes education programs (DEPs) have nonetheless yielded inconsistent results.

While there are numerous factors which have the potential to influence the educational process, this study explored the impact of a group diabetes education program based on Social Cognitive Theory on the cognitive processes (psycho-social skills) which are believed to support self-efficacy and outcome expectations.

Using a case study design, data was collected through structured interviews and surveys from participants in a group diabetes education program conducted in Brisbane. The broad findings of the current study were that:

1. outcome expectation beliefs changed substantially for most participants (as anticipated by the study), although the extent of biomedical knowledge acquisition was highly variable across the group.

2. cognitive change with respect to the knowledge of psycho-social processes was highly variable, with some participants manifesting no real change. This finding was (only) in partial correspondence with the anticipated changes.

3. several factors appeared to have impacted significantly on the DEP outcomes. These factors included: the level of diabetes educator skill and self confidence; the DEP participants' existing belief systems and cognitive flexibility with respect to psycho-social theories about motivation and confidence; the impact of group dynamics on 'learning to live' with diabetes; and contingent health issues influencing learning and learning transfer.