AADE7 framework fosters self-management education and care

Self-care behaviors for diabetes self-management defined.

The American Association of Diabetes Educators’ position statement provides guidance for diabetes educators and health care providers to apply the AADE7 Self-Care Behaviors, according to the position statement authors.

“This position statement is put forth by the AADE to provide clarity about application of the AADE 7 Self-Care Behaviors framework in diabetes education and care, as well as describe widespread extension to other chronic diseases and wellness,” Donna Tomky, CDE, told Endocrine Today. Tomky is a nurse practitioner and diabetes educator in the department of endocrinology/diabetes at ABQ Health Partners in Albuquerque, N.M.

The AADE7 framework was incorporated into the 2007 National Diabetes Self-Management Education Standards. The standards complement the National Standards, which are intended to direct educators to measure behavior change as well as clinical and health status outcomes at regular intervals both preintervention and postintervention, according to the authors.

The seven self-care behaviors are healthy eating, being active, monitoring, taking medication, problem solving, healthy coping and reducing risks.

Standardized terminology key

“The importance of common and standardized terminology or nomenclature in diabetes self-management education cannot be overemphasized,” the authors wrote. “Standardized nomenclature gives diabetes education greater coherence and enhances the quality of care delivered to people with diabetes.”

According to the authors, using standardized terminology allows for the following:

• Improved communication among health care professionals, patients and the diabetes care team.
• A diabetes self-management education knowledge base on a global level.
• Research, comparisons and evidence-based practice.
• Shared information and the development of benchmarks that aid in the discovery of what constitutes best practice.
• A single terminology that can be used across the globe.
• A way to clarify and define processes and outcomes to consumers, third-party payers and hospital and medical management.
• Documentation to effectively measure the diabetes education process.

Behavior change

“The Diabetes Self-Management Outcomes Continuum depicts an iterative process of measuring, monitoring and managing outcomes phases, and the AADE7 framework provides a clear view of where diabetes education fits into the diabetes care continuum,” the authors wrote.

The Continuum defines behavior as a primary outcome of diabetes education: “It is a key element in attaining or maintaining desired levels of clinical parameters and in turn health and health-related outcomes,” according to the authors. “Behavior often is not sufficient to achieve these states and outcomes, but it is an essential component of what is required.”

Behavior is a consequence of a variety of factors that can be directly influenced by diabetes education, including not only diabetes self-management knowledge and skills but also behavior change goals, treatment self-efficacy and barrier management/resolution strategies, according to the authors.

The continuous quality improvement process has the goal of providing more effective and efficient service while ensuring optimal patient care and measures, monitors and manages the AADE7 behavioral outcomes.

“It is AADE’s position that at least one formal continuous quality improvement project be related annually to the assessment of behavioral outcomes for the entire population of patients served or for a representative sample,” the authors wrote. “In this way, individual educators or programs can continually assess the impact of their program as well as the progress of the program participants.”

Applying it to health care

“Changing diabetes educator’s current practice behavior from a content-driven practice to an evidence-based practice that focuses on behavior rather than curriculum is a challenge for implementation,” Tomky said. “Dissemination of the AADE7 framework to the diabetes community has been challenging.”

However, the framework provides standard nomenclature for patient assessment, problem solving, barrier identification and resolution, goal setting, documentation, measurement, evaluation and continuous quality improvement; it provides consistent measures for conducting research to provide for evidence for use in advocating for health care policy, according to Tomky.

The AADE7 framework extends to assisting in the chronic medical arena for conditions such as hypertension, hyperlipidemia, heart failure, asthma and osteoarthritis, as the seven behavior outcomes are necessary for these individuals also, according to the authors.

The framework “can be adapted for health promotion and disease prevention strategies such as smoking cessation, obesity and weight management,” they wrote. It can also be modified and/or incorporated into the management of any chronic health condition or wellness program that requires an emphasis on problem solving, effective lifelong coping, behavioral change and patient empowerment, according to the authors.

“The AADE7 Self-Care Behaviors provide the necessary framework for confidently driving diabetes education practice, allowing for benchmarking, setting standards and universal measurement of the effects of diabetes educators and diabetes self-management education,” the authors wrote. – by Christen Haigh

The Diabetes Educator. 2008;34:445-449.

Concrete Examples for the Seven Self-Care Behaviors

Healthy Eating - Simple methods of teaching patients about healthier choices or alternatives can facilitate improved glucose control and weight loss. Being active - A patient might find riding a bike, using public transportation or walking to work as means to increasing physical activity. Monitoring - Getting a patient to check two hours post prandially can give them a different perspective on their diabetes blood glucose landscape. Often patients see the impact on their blood glucoses by changing their food choices or portion sizes, increasing physical activity or adjusting their medication such as insulin doses. Taking Medications - Providers often assume the prescribed medication is taken properly, but one of the first questions I ask my patients is when and how do you take your medication. It is amazing to see the improvement in outcomes when the timing, dosing or missing of medication behavior is corrected. Problem-Solving - Blood glucose monitoring results can be linked to problem solving self-care behaviors. Patients can quickly learn what affects their blood glucose. With that information, they can take action to correct a high or low blood sugar by adjusting food, activity or medication and sometimes the environment. Healthy Coping - Applying coping or stress management strategies such as engaging in support groups, counseling or improving provider-patient communication can improve a patient’s ability to cope with their chronic illness. Reducing Risks - Some risk reducing behaviors include encouraging and reminding patients to get eye exams, if appropriate, taking low dose aspirin or inspecting their feet daily. Source: Donna Tomky, MSN, RN, C-ANP, CDE