An Editor’s Eye and an Empathetic Heart: A Diabetes Dialectic and PairedReading ActivityActivity 2C
Focus:This activity utilizes fictional and non-fictional accounts as a means toextrapolate both affective and cognitive aspects of living with diabetes.
Activity Objectives:Students will be able to:
u Complete “dialectic” responses to the fictional account, “Manage Me”
u Compare and contrast fictional (“Manage Me”) and factual accounts (“Drawing Out Diabetes”) of the health issues related to Type 1 and Type 2 diabetes (diabetes risk factors, disease onset and symptoms, disease management, related health compromises)
u Construct a graphic organizer to illustrate the similarities and differences between the fictional (“Manage Me”) and factual (“Drawing Out Diabetes”) accounts of health issues related to Type 1 and Type 2 diabetes
u Read a variety of text formats
u Read selected materials for understanding
u Participate in class discussion about diabetes and demonstrate active listening
u Investigate the emotional, social, and physical impact that the diagnosis and management of Type 1 and Type 2 diabetes has on the lives of fictional characters in the story, “Manage Me”
u Consider the benefits of “shared experiences” and “group dynamics” in understanding health information and applying that information to improve one’s “health behavior”
u Consider how some feelings, such as isolation, fear, and anger, can be shared and understood even if the circumstances resulting in these feelings are different
Sensitive Content:Teachers must be aware that some students may be living with concernsabout their own diabetes or that of family members or friends. In read-ing the story provided in this activity and reacting to the characters andcontent, students may feel prompted to share their personal stories, orthey may experience emotional moments that require a brief time to distance themselves from the learning task; perhaps they will need timeto process these feelings with a teacher, school nurse, counselor, peer, or family member. Know that some students may not disclose their concerns at all, but will appreciate the respectful and non-judgmentalattitude modeled by the teacher. Even though the activity uses on a fictional story, the elements are real and personal to those dealing withthe onset, management, and complications related to diabetes. While itis not expected that every teacher take on a counseling role, teachersshould be aware of any services available on their campus, within theirschool district, or community to whom students may be referred.
Activity Description: Using guided dialectic and paired reading strategies, the fictional story,“Manage Me,” provides teachers with a non-threatening way to intro-duce the complex and sensitive health issues that envelope a diagnosisof diabetes. The activity allows students to use the story to examine the emotional and social impact of diabetes. Using the non-fictional(“Drawing Out Diabetes”), students will analyze the accuracy of the diabetes information and health content portrayed. Thus, the activity is divided into two parts – the first part dealing with the affective learn-ing domain (emotional and social growth) and the second with the cognitive domain (health content).
Part One“Why me?” That is a question many students have asked themselves. Inthis activity, students will meet Claire, who struggles with the answer to“why me” as she works through the stages of grief following her diagno-sis of Type 1 diabetes. Through Claire’s eyes (and those of the otheryoung people at Camp Running Water), students will get a sense of theemotional struggles that accompany a diagnosis of diabetes, and observethe value of sharing this diagnosis with others who are also learning totake control and manage their own disease. Students will use theresponse section provided with the story, “Manage Me,” to reflect uponthe portrayal of Claire’s feelings. The dialectic format has both guidedquestions and open space for independent reflections. For some pas-sages there are prompts that require students to respond; other passagesare left open for students to create their own reflections. The reflectionsmay take the form of a summary of the passage, or may be a reaction tothe passage – perhaps a simple comment about what is written, perhapsa strong feeling incited by the information or interaction depicted, per-haps a question, or something they would like to say to the character(s)
in the story. In addition, students will use a blue highlighter to identifythe “feelings” shared by the character(s) in the text of the story. The feelings may be specifically stated or described in the text, or perhaps“sensed” by the students and so noted in their reflections.
Teachers may use this dialectic format or the narrative format providedwith the activity–see activity modifications.
The narrative format contains the story “Manage Me” in straight text.The reflective questions can be found on separate pages following thenarrative. Teachers may wish to use a class set of the narrative thenguide students in organizing their own dialectic responses onto note-book paper. If using the narrative format, teachers may wish to extractselected passages for students to complete the highlighted tasks.
Part TwoWhile this fictional story is based in diabetes “facts”, students must beskeptical readers and use an “editor’s eye” to examine the accuracy withwhich the diabetes information is presented. In the second part of theactivity, students will examine the snippets of diabetes information presented in the story. Students will mark these facts with a yellowhighlighter. Students will use their analytical skills to examine the accuracy with which the story represents diabetes. Are the facts over-stated? Are they incomplete? Are they subtly misleading? Are they totally wrong? Upon completion of the reading, responding, and high-lighting portions of the activity, students will compare and contrast the“facts” from the story with the factual elements presented in the studentresource pages, “Drawing Out Diabetes.” Students will then design theirown graphic organizer (such as a Venn diagram or tabular chart) to present the similarities or differences they have observed between thefact sheet and the “facts” in the story.
Activity Background:Usefulness of the Dialectic DesignA dialectic design denotes a way to facilitate conversation, reasoning, ordiscriminating “truth” from “error.” In this activity, students are beingasked to think critically about what they will read and use a responsesection in the student activity pages to make notes of their thinking. It isa way to “have conversation,” if you will, with the text that you arereading. Many teachers use some form of dialectic or responsive writingprompts or formats to help student better comprehend what they readthrough guided and unguided interactions with the text. The use ofdialectic notebooks and reflective responses is a familiar strategy in thereading classroom. A report in the Journal of Engineering Education(Lackey, et al) suggests that the grades given to a freshman engineeringstudent’s dialectic notebook are good predictors of academic success inthe Mercer University School of Engineering. A four-point rubric wasused to score the notebooks in this study; scores were compared with
the student’s academic standing at the end of the freshman year. Theresearchers found that 67% of the students scoring a zero or a one ontheir notebook completed their freshman year at risk: academic warn-ings, academic suspension, or academic probation. Of the students whoscored two or better, only 7% were struggling academically at the end of their first year. The authors suggest that the discipline involved inresponding to and maintaining a dialectic notebook contributes to student success. They felt that the dialectic notebook was a vehiclethrough which “student engagement, attitude, initiative, time manage-ment skills, study habits, and willingness to persevere” could be meas-ured. Maintaining such a notebook indicated a “willingness of the student to invest time in learning.” The story, “Manage Me,” is writteninto a dialectic format. Written in the left hand column of the studentactivity page is the story text in numbered segments. The right hand column is the student response area, also numbered to correlate withthe text. The response area contains some prompts to guide studentinteractions with the text, however, some portions are open to studentsso that they may write any thoughts, summaries, or questions they haveabout the story. While not a semester-long assignment as in the case ofthe engineering students, it is an assignment that requires the same diligence and promotes thoughtful interaction with the fictional text.
Science teachers might explore and incorporate other useful responsivewriting strategies in the science classroom, including learning logs andinteractive notebooks (Steenson, 2006; Young, 2003).
Analysis of Fictional Content with Diabetes FactsUnless a student has direct experience with managing diabetes, the allusions to diabetic care in the story may not provide the depth that isneeded to completely understand what the characters are doing or whatthey are talking about. Thus, in the second part of the activity, studentsare asked to compare and contrast the diabetes health information provided in the fictional story with factual diabetes information. Thefacts are provided in an additional reading segment, “Drawing OutDiabetes,” whose content was extracted and compiled from NationalInstitutes of Health (NIH) resources (particularly the National Instituteof Diabetes, and Digestive and Kidney Diseases – NIDDK,http://www.niddk.nih.gov/), the American Diabetes Association (ADA)(http://www.diabetes.org/home.jsp), and the Texas Diabetes Institute(http://www.texasdiabetesinstitute.com/). While this tool broadly encompasses diabetes information, it may not provide all of the data astudent may need to address the particular discrepancy or concernsthey may have about the “facts” within the “Manage Me” story. If additional information is needed to help students process their comparison of “fact” and “fiction”, teachers may select from the manyeducational elements found at the above mentioned websites, or mayuses trusted resources found in their school library.
Students will use their fictional text (“Manage Me”), their responsivenotes (dialectic segment and highlighting on the “Manage Me” pages),and the fact sheet (“Drawing Out Diabetes”) to compare and contrast the diabetes content. Their analysis is to be arranged into a graphic organizer – a visual tool used across disciplines to organize informationand improve comprehension and retention of information – of their own design.
In a literature review conducted in 2003 by Appalachia EducationalLaboratory (AEL, new corporate name is now Edvantia) and contractedby Inspiration Software®, Incorporated, the authors distilled five rea-sons to use graphic organizers “across the grade levels, with diverse stu-dents, and in a broad range of content areas.” These reasons includeimprovements in a) reading comprehension, b) overall achievement, c)thinking and learning skills, d) retention and recall, and a final reason touse graphic organizers is that they e) assist teachers in implementingvarious cognitive learning theories (including dual coding, schema, andcognitive load theories) (AEL, 2003). An archived slide show on theSouthwest Educational Developmental Laboratories website, byRosanna Boyd (extracted at http://www.sedl.org/secac/xp01.html, shown as part of a workshop series on “Instructional Strategies for EducatingLimited English Proficient Students in Secondary Schools”), shares additional rationale for using graphic organizers in the classroom andillustrates several models – including the wheel, the tree, the Venn diagrams, word maps – and lists a number of resources.
Diabetes CampsThe setting for the story, “Manage Me,” is at a diabetes camp. WhileCamp Running Water is a fictional camp, there are many real diabetescamps throughout the world whose focus is to help people with dia-betes lead healthy and productive lives. Other campers who live withpersons who have diabetes may also attend and learn about the diseaseand its management, and how to support their family member with diabetes. Students in your classroom may be interested in attendingsuch a camp. Information about the locations of diabetes camps may be obtained from a physician, from the American Diabetes Association(ADA), or from the Diabetes Education and Camping Association(DECA). The DECA is an international organization that helps physicians, medical groups, and existing camp facilities to create specialcamping opportunities for children with diabetes. They provide trainingfor camp directors and protocols for diabetes treatment. A listing ofcamp grounds offering diabetes camps can be found on the DECA website (http://www.diabetescamps.org/camplist.php.) While DECA can assist in setting up the appropriate diabetes components for a camp,accreditation of camps is done through the National CampingAssociation (http://www.acacamps.org/).
Management of diabetes is a very personal and private matter. Manytimes, a person with diabetes finds great comfort and affirmation byattending a diabetes camp. There is much that a diabetic person mustlearn about his/her disease and self-care. Diabetes camps promote learn-ing as much as possible about diabetes. This is one of the key principlespurported by the NIDDK in their excellent resource entitled “For Peoplewith Diabetes: 7 Principles for Controlling Your Diabetes for Life”.This resource may be useful to students who have family membersnewly diagnosed with diabetes, and may also be useful in helping students in preparing their graphic organizer to compare/contrast theaccuracy of the story with the reality of managing diabetes. It may befound at: http://www.ndep.nih.gov/diabetes/pubs/7Principles_Eng.pdf.Their seven principles include: 1) Learn as Much as You Can AboutDiabetes, 2) Get Regular Care for Your Diabetes, 3) Learn How toManage Your Diabetes, 4) Control the ABCs of Diabetes, 5) Monitor YourDiabetes ABCs, 6) Prevent Long Term Diabetes Problems, and 7) GetChecked for Long-Term Problems and Treat Them. It also includes a diabetes care record template to assist in keeping track of informationuseful in regular health care visits.
Activity Instructions & Management Suggestions:Explain to students that they will read a story that reflects some of theexperiences of young people who have either Type 1 or Type 2 diabetes.As they read “Manage Me,” students will “interact” with the storythrough the use of the two-column dialectic format provided in the student pages. There are several ways in which the student may do thisand the column to the right is the first place to start. In some parts ofthis column, there are some prompts provided to which students mustrespond; in other places, there is empty space provided for their ownideas as they read the story. For example, students may select one ormore characters with whom to “interact” – to respond to as they read.They may interact with the text by making notes, identifying difficultterms, questioning some action that was taken, responding to a character’s comments or behavior, suggesting ways in which the feelings exemplified in the story are similar to feelings they may havehad; noting if they empathize with the character and how so; recalling a time when they were at camp, or got “the look” from their mom;drawing “the look”; sketching what the camp compound might looklike; sketching how one or more of the characters may appear; acknowl-
edging or questioning any references to diabetes management, compro-mises, or complications; summarizing or identifying the main idea ofthe numbered passage; rewriting the passage; making an intuitiveresponse or guess about what might happen next in the story; “counsel”or “praise” one of the characters; counter or support a “diabetes fact” as presented in the story! On the list goes! Use your imagination inhelping students fully engage in the story.
The fictional account may be read aloud in class, with appropriate timegiven for individuals to respond, or may be read silently, with responseand discussion to occur later. Students will read with “an editor’s eyeand an empathetic heart” – this means a couple of things: what they arereading is a piece of fiction based on factual information, for the mostpart, and while they read they can think about some of the emotionsdepicted by the characters and how they would feel if they were thecharacter in the book. Given these reading viewpoints, teachers mustencourage students to interact with the text, to fill the column to theright (and then some) with their responses to the story, questions theymay have, and concerns/insights they gain into various issues associatedwith diabetes. Thus, time must be allotted for this level of interaction –this may occur in class, or as homework. The discussion about the storyand any sharing that students may want to do from their dialectic noteswill need to be done in class. The teacher should demonstrate the kindof sensitivity and consideration that is asked of students as they respondnot only to the characters in the story, but to each other. The storystrives to enrich the student’s factual knowledge about diabetes, but isdriven through the affective domain – the character’s emotional andsocial growth. Affective learning goals “are attitudinal in nature and donot have students’ intellectual growth as their primary focus.” (Eggen,Jauchak, and Harder, 1979, page 40). Among other things, teachers whotap into the affective learning domain need to allow time and opportu-nities that help students identify and offer solutions to interpersonaland social issues. In addition, teachers can encourage that students usethe story and dialectic comments to bring up diabetes as a topic of dis-cussion with their families. In doing so, students may learn a wealth ofknowledge about the resilience and adaptability of their family memberswho battle with the daily care and management of their diabetes.
As critical readers, students will also identify and highlight “diabetesfacts” that are mentioned or perhaps alluded to in the text. Later, theywill compare the facts from this fictional account, with facts from thehealth information pages, Drawing Out Diabetes. (These informationpages have been created using the resources of the National Institutes of Health – National Institute DDK, American Diabetes Association, andthe Texas Diabetes Institutes.) As a product of this comparison of “diabetes facts,” students will generate their own graphic organizer inwhich to catalogue their thoughts. Be aware that students are likely topresent quite a variety of mechanisms to show what they have
discerned. In grading these products, the teacher should look at whatthe students found that would correct a misconception in the story, orimprove a reader’s understanding of diabetes, and how that “fact” isarticulated. Students may or may not use all of the elements they havehighlighted, but it is anticipated they will find three or four things thatcould be changed/corrected or added that would improve the under-standing of diabetes as a disease or improve the reader’s perceptions ofdisease management and progression. Additionally, it is anticipated thatstudents will vary in the amount of direct instruction and guidance they will need in preparing their compare/contrast graphic organizer.Teachers know what capacity their students have to generate graphicorganizers and thus, may leave this design as open or as guided as necessary for the individual students in their classrooms.
Modifications:Teachers may opt to use the “narrative” format of the story “ManageMe” along with the suggested questions rather than the “dialectic”/“response” format (which is more “paper intensive”.) In this case, students will set up their own notebook paper in a response format assuggested by the teacher. This might include 4 columns labeled“Paragraph Number”, “Emotions/Feelings”, “Diabetes Facts”, and“Responses”. (See Appendix 1 and 2 at the end of this activity.)
Teachers may provide a template for students to use in generating their graphic organizer comparing the fictional and factual accounts of diabetes.
Teachers may wish to reinforce learning or preface this activity withLesson 2, “Compare and Contrast Type 1 and Type 2 Diabetes” of the Bittersweet: Diabetes and Aging unit of study (found at:http://www.teachhealthk-12.uthscsa.edu/pa/pa10/1002A-diabetes.htm).In this activity, the student is given a table on which information abouttype 1 and type 2 diabetes is organized. Then the student is instructedto “re-organize” that information into a guided Venn diagram.
Extensions:Students may wish to use personal experience and reflection to createone of the following: 3 a story about a time when they experienced feelings similar to
Claire’s or other characters in the story. 3 a new paragraph in the story which introduces another camper
who responds to Claire or other characters in the story.3 an essay from their experience reflecting how the “affective”
Students may use multiple sources to investigate a variety of factorsrelated to Type 1 and Type 2 diabetes onset and progression in order todevelop one of the following:
3 a new paragraph for the story that clarifies an error or misconception in the diabetes “facts” as presented in the story.
3 a report on the manufacture of insulin and its daily use by Type 1 diabetics.
3 a supportive, encouraging letter to someone they know who has diabetes.
3 a research report on how “attitude” affects “health.”
Teachers may invite a guest speaker who is willing to share his/her per-sonal story of a life with diabetes. Have students prepare questions theywould like to ask the guest speaker. Have those questions available inwritten form in advance of the speaker’s arrival to the classroom. In thisway, the speaker can make sure to include information that will directlyaddress those questions or may make it very clear to the class that thereare some things he/she will chose not to share.
References:A.E.L. Graphic Organizers: A Review of Scientifically Based Research.(July 2003). Prepared for Inspiration Software®, Inc. by The Institute forthe Advancement of Research in Education (IARE) at AEL. Charleston,West Virginia: Appalachia Educational Laboratory.
Abramson, Lorne. Personal communications with Lorne Abramson,Executive Director, Diabetes Education and Camping Association(DECA), P.O. Box 385, Huntsville, Alabama 35804.
Coburn, Daniel. Using graphic organizers. Science Scope; September,2003, pages 46-48.
Eggen, Paul D., Donald P. Kauchak, and Robert J. Harder. Strategies forTeachers: Information Processing Models in the Classroom. EnglewoodCliffs, New Jersey Prentice-Hall, Incorporated, 1979
Lackey, L.W., W.J. Lackey, H.M. Grady, and M.T. Davis. Efficacy of usinga single non-technical variable to predict the academic success of fresh-men engineering students. Journal of Engineering Education (January2003); accessed electronically, April 1, 2006 at: http://www.looksmartgradschools.com/p/articles/mi_qa3886/is_200301/ai_n9182475#continue
Pruski, L. “Manage Me” chapter from a larger body of work being prepared for publication. San Antonio, Texas: 2006.
Steenson, Cheryl. Learning logs in the science classroom. Science Scope;April/May, 2006, pages 35-36.
Wolfer, S. (2004). Stephen Furst: Diabetics in Denial, Psychology Today.
Young, Jocelyn. Science interactive notebooks in the classroom. ScienceScope; January, 2003, pages 44-47.
Special thanks to the following for their invaluable advice indeveloping this activity:
Virginia Odle, Kathy Hopson, Amanda Wells, Erica Bayless, Linda McManus, Maureen Mazar, Lorne Abramson, Shirley Ashby
