Health care facility-based interventions often entail diabetes counseling by a health care provider (e.g., doctor, nurse, or health educator) in public or private health care settings (e.g., doctor’s office, hospital, health department, or assisted living facility). These counseling sessions may require reminders or prompts for the provider to discuss diabetes and related risk factors or health conditions. These interventions can also include training for health care professionals on the importance of diabetes prevention and management (e.g., glucose monitoring, nutrition, physical activity, taking medication, or quitting smoking). Some of the challenges in the health care setting include the limited time physicians or health care providers may have to visit with their patients and the risk of information overload because of competing or related health priorities. Referrals to other community resources can also be an important part of interventions in health care settings.
Health care facility-based interventions are most effective when links to interventions in other settings are established:
- Community-based (e.g., involve trained health care providers in efforts to advocate for policies to cover or reduce costs of diabetes test kits or medications and in community education efforts to increase accuracy and credibility of diabetes information)
- School-based (e.g., educate school nurses on the importance of supporting diabetes management behaviors)
- Worksite-based (e.g., make nutritious foods and facilities for physical activity available for employees in health care settings)
- Faith-based (e.g., work with faith-based networks to increase community outreach and access to information about diabetes)
- Home-based (e.g., encourage families to visit their health care provider regularly)
Before You Begin…
There are a number of planning steps that lead to a variety of specific intervention strategies. For assistance with these planning steps, use the navigation bar at the end of this page. Intervention MICA provides you with tools to help you:
- Create a partnership with other individuals, groups and organizations within your community.
- Learn about your readiness to plan your intervention (readiness and preparation).
- Work on your organizational or community capacity, budget, funding sources, social determinants of health, or cultural competence (capacity).
- Prepare your evaluation in order to figure out how to measure the success of your intervention.
- Maintain your momentum through information, tools and resources to assist you in sustaining your partnership and intervention over time.
Below are specific intervention strategies for health care facility-based interventions. If you will be working in other settings (e.g., communities, schools, worksites, faith-based organizations or homes), then you will want to refer to these other settings for more information.
Intervention Strategies
Even though the intervention strategies that may be used are described separately below, each of these strategies is most effective when it is combined with other strategies. For example, changing health care providers’ knowledge, attitudes and beliefs about diabetes prevention and management may do little to affect behavior unless the provider has time to counsel and provide encouragement to their patient during office visits. Likewise, the health care facility will need to model appropriate policies to support availability of nutritious foods and opportunities for physical activity in these settings.
It is important to make sure that the intervention strategies are created to represent and address the needs of the Community of Interest. This may include paying attention to how different groups think about different diabetes prevention and management. For example, diabetes may be much more common in some communities, and, therefore, community members may believe that it is unavoidable. Furthermore, an intervention works best when there is an attempt to address language, reading level, and cultural barriers (see Cultural Competence for more information). For information on different populations that have received diabetes interventions, go to Diabetes in Different Populations.
--Increasing knowledge and skills, influencing attitudes and beliefs
Individual Information Exchange intervention strategies have been developed to increase individual knowledge and skills as well as to change attitudes, beliefs and behaviors related to diabetes. More specifically, these interventions may provide personally tailored information about the benefits of healthy lifestyles (e.g., balanced nutrition, physical activity, or quitting tobacco use), beliefs about health conditions related to diabetes (e.g., foot problems, kidney problems, vision problems) or management of diabetes (e.g., monitoring glucose, taking medication). Tailored information may take into account the person’s readiness for change or specific interests in order to help them prevent or manage diabetes. These interventions are also useful in helping individuals develop skills to seek assistance from others when needed (e.g., transportation to a pharmacy to purchase a glucose test kit).
Mass Media Campaigns are interventions that address messages about diabetes to large audiences. The campaigns are designed to increase knowledge as well as influence attitudes and beliefs. Messages are communicated using newspapers, radio, television, Internet, posters, pamphlets, brochures, newsletters, videos, direct mail and billboards with generic, untailored information.
Group Education Sessions are interventions focused on provision of information and are delivered through health education classes or group sessions. They provide education and skills related to decision-making and usually have multiple components, including: diabetes and health, glucose monitoring, medication, balanced nutrition, physical activity, tobacco use, other skill-building techniques, role playing, lectures and information. Health education classes are designed to affect behavior change through personal and behavioral factors that provide participants with the skills they need to make informed decisions. Because of the interactive nature of group settings, participants have the opportunity to learn new information, ask questions, get support from other participants and the facilitator or instructor, and practice new skills.
Provider Education Systems are interventions targeting health care providers (doctors, nurses, clinicians, health practitioners) to encourage them to educate their patients regarding the importance of diabetes prevention and management. Provider education systems include educating the providers on the importance of talking to their patients or clients, reminding providers to talk to their patients or clients during routine visits, and offering feedback to providers regarding their performance in delivering diabetes advice or assistance to patients or clients.
--Providing social support
Supportive Relationships are interventions that build on social or interpersonal relationships (e.g., family members, co-workers, friends, peers, role models) in order to provide a support system for behavior change. This may include increasing the information individuals have about diabetes (informational support), the skills and abilities people have to monitor their glucose and take their medication (tangible support), and the sense of acceptance and belonging among people with respect to eating balanced meals, getting physical activity, or quitting tobacco use (appraisal support). Examples of social support strategies include: group discussions, partner support, peer leaders, and parent-child interactions.
Group Education Sessions (see description above)
Provider Education Systems (see description above)
--Changing public policies and the community environment
Environment and policy initiatives are interventions that attempt to increase access to resources for diabetes prevention (e.g., increase availability, reduce cost, increase quality, and increase variety related to nutritious foods and physical activity facilities) and for diabetes management (e.g., increase availability and reduce costs associated with glucose test kits and diabetes medications).
Health Care Facility-Based Resources
State of Missouri Consensus Screening Guidelines for Pre-diabetes and Diabetes in a Medical Setting
Missouri Consensus Diabetes Management Guideline for Adults
American Diabetes Association Diabetes and Cardiovascular Disease Toolkit