New BeginningsA Discussion Guide for Living Well With Diabetes

BACKGROUND

Focused on helping African Americans with diabetes and their families manage the emotional impact of diabetes.

Why African Americans?

• African Americans are more likely to be diagnosed with diabetes than many other groups.

• Emotional health is an important part of living with diabetes.

• New Beginnings is tailored to meet the needs of African Americans with diabetes.

CDC, 2011

The Emotional Impact of Diabetes

• Diabetes is a 24/7 condition.

• People with diabetes are responsible for managing their health over their lifespan.

• People with diabtes may also be dealing with other health issues.

• Diabetes can lead to changes that affect mood and self-care behaviors.

• Every day challenges can make it difficult to manage diabetes.

“It takes a lot of discipline to get diabetes under control. But the first thing you have to do is accept that you have diabetes and you have to make up your mind you’re going to

do whatever it takes…to get this disease under control because if you don’t control this disease, it is

going to take charge of you.”

- Yvonne

Diabetes Affects the Entire Family

• People with diabetes have to make changes that may affect others in the household.

• Family members may have to help care for the person with diabetes.

• Family members may be dealing with their own health challenges.

“…it really does not work if you’re making separate meals.. We

have to eat as a family. We have to support one another as a

family and if it really is in sickness and in health then you become

one and you eat the same foods.”

- Jaquie

The Importance of Family and Social Support

• Social or family support can have a negative or positive impact on the person with diabetes.

• African Americans with diabetes may rely more on family and social support than other populations.

• A lack of social support may have a worse impact on African Americans than other groups.

• Social support can be an important part of improving quality of life.

“Communication and talking to each other and talking about the emotional part of living

with diabetes helps to alleviate some of the frustration and the

denial. A lot of us get to the point…we don’t want to deal with it, but it’s something that

we all have to deal with, whether we like it or not, its

there.”

- LyCynthia

Ford, M., Tiley, B., & McDonald, P. (1998)

Tang, T., Brown, M., Funnell, M., and Anderson, R. (2008)

A Word About Stigma• It is often difficult for many groups to discuss issues of

emotional and mental health.

• African Americans may be more likely to perceive a stigma attached to mental health.

• African Americans may not feel comfortable discussing personal matters with those outside of their family or cultural group.

• African Americans may be more likely to rely on spiritual or family support.

Ford, M., Tiley, B., & McDonald, P. (1998)

Goals of New Beginnings

• Help African Americans with diabetes:– Manage the emotional impact of diabetes.– Build positive supportive relationships with family

and health care providers.– Develop skills for

• Goal setting• Problem solving• Positive coping• Improved self-efficacy• Health literacy

New Beginnings

• Lead discussions about the emotional side of living with diabetes.

• Help people with diabetes and their loved ones:– Develop goal setting, positive coping,

and problem solving skills.

– Identify family and social support needs.

– Learn positive communication skills.

Storytelling in New Beginnings• Uses the stories of people with diabetes and

their families to stimulate discussion.

• Stories help:– Open conversations– Model skills and behaviors– Increase retention of information– Overcome barriers to discussing

personal information– Bridge cultural divides

What’s New in New Beginnings• Shorter and more flexible.

• New stories and story formats.

• More focused on behavioral outcomes.– Activities address multiple learning styles.

• New module on emergency preparedness.

• New implementation support resources.– Planning, evaluation and promotion tools– Training programs (continuing education available)

New Beginnings ModulesModule Topics Covered

Module 1. Overview: Living Well With Diabetes Diabetes ABCs Managing diabetes Supporting a loved one with diabetes

Module 2. Know Your ABCs Diabetes ABCs Managing diabetes Goal setting

Module 3. Healthy Coping Emotional coping Depression Providing emotional support

Module 4. Overcoming Self-Doubt Building self-confidence and reducing self-doubt

Goal setting

Module 5. Managing Stress Stress management

Module 6. Problem Solving and Emergency Preparedness

Problem solving Emergency preparedness

Module 7. Children and Family: How Can They Understand?

Communicating with children and family members

Building social support

Module 8. Working With Your Doctor Preparing for health care visits Roles for family caretakers

Connecting Threads

Who should participate in New Beginnings sessions?

• People with diabetes• Family members

– Spouses, partners and other loved ones

– Children (12 and over)– Close friends

• People who are not African American

Who Can Use the Guide?

• Diabetes Educators• Health Educators• Community Health Workers• Health Ministers• Support group leaders• People with training or

experience leading group discussions

Medical advice is not offered during New Beginnings sessions.

Where Can the Guide be Used?• Any setting with:

– Privacy– Comfortable seating– Equipment for showing or playing the stories

• Discussions are designed for groups of up to 10 people– Can be incorporated into existing education

programs– Can be used in one-on-one patient counseling– Can as a part of large group panel discussions

ROLES FOR DIABETES EDUCATORS

New Beginnings and Diabetes Self-Management Education

• In addition to self-care behaviors diabetes self-management education should include:

Funnell, et. al., 2007

– Goal setting – Problem solving– Developing strategies to

support emotional well-being and health, and behavior change

New Beginnings and AADE 7 Self-Care Behaviors™

• Healthy eating• Being active• Monitoring• Taking medication• Problem solving• Reducing risks• Healthy coping

• New Beginnings addresses problem solving and healthy coping directly

• Other knowledge and skills support adoption of the other self-care behaviors

http://www.diabeteseducator.org/ProfessionalResources/AADE7/

Roles for Diabetes Educators

• Facilitators

• Supervisors/Advisors

• Evaluators and researchers

ROLES FOR COMMUNITY BASED ORGANIZATIONS

Who has a role in supporting people with diabetes?

• Faith communities• Worksites• Social, civic and service

organizations

Roles for Faith-Communities• Faith communities focus on core values and

skills important to behavior change.– Help link deeper values to health choices.– Provide support to overcome denial.– Support improved family communication and

relationships.

• Offer New Beginnings to members and the larger community

• Partner with health and community organizations to support educational activities

Roles for Worksites• Improved diabetes management can result in:

– Increased productivity– Less absenteeism– Lower medical costs– Healthier employees and retirees

• Offer groups to employees with diabetes or those who have family members with diabetes.

• Partner with health and community based organizations.

Is Your Organization Ready for a Diabetes Support Group?

• Support groups – Meetings of people with something in common.– Focus on learning coping skills and strategies.

• Support groups are not group therapy and are not used to diagnose or treat an illness.

Is Your Organization Ready for New Beginnings?

• Would the members of your community benefit from a diabetes support group?

• Does your community have people who could organize and lead a support group?

• Does your organizations have the resources to support a group?

Other Ways to Support New Beginnings

• Offer your space for New Beginnings groups led by diabetes or health educators

• Refer your members to New Beginnings or diabetes education groups going on in your community

• Partner with diabetes education or health education programs to help make them more culturally relevant to your community

GETTING STARTED WITH NEW BEGINNINGS

Decide How You Will Use the Guide• What are the needs of your participants?

• Will you integrate into existing groups or create a stand-alone program?

• How often will your group meet?

Review the Modules

• Each Module follows the same format:– Background– Objectives– Suggested materials

• Stories• Handouts• Equipment

– Group Discussion– Exercises– Homework– Expand this Module section

Review the Modules – Background and Objectives

• Background information and summary of key points.

• Knowledge and skills participants should gain from the module.– Based on behavior

Review the Modules - Stories

• Most of the stories are told by real people with diabetes.– The stories are discussion aids and not intended to

offer advice or recommendations.

• Each module offers multiple story options.– Pick the story that meets the needs of your group.– Use your own stories.

• The stories come in multiple formats.– Audio, video and print

Review the Modules – Group Discussions

• Part 1: The person with diabetes• Part 2: Family support and/or skill building

Discussion Format in the Guide

Review the Modules - Exercises• Each module has 2 – 3 exercises that can be

included in the session.– Think about how to use what has been discussed. – Practice new skills.– Plan to make behavior changes.

• Each module includes a “think-pair-share” activity.

• Optional homework exercises.

Review the Modules – Expand this Section

• Additional resources.

• Additional handouts, videos and other materials.

Adapting the Modules• Make the sessions longer or shorter.

• Combine different modules.

• Add additional content from the connecting threads session.

• Use different stories.

• Present the modules in any order that makes sense for your group.

Adapting the Modules• When adapting the guide remember to:

– Keep the needs, culture and beliefs of your participants in mind.

– Keep the focus on participants’ experiences living with diabetes.

– Keep the focus on behavior change.

Getting Ready for a Session• Review the discussion questions.

– Focus on questions that will be most relevant to your group.

• Review the exercises.• Review the Connecting Threads section for additional

questions or exercises.• Review the homework if appropriate.• Use the “Session Plan Template” to organize your

session.• Prepare handouts worksheets and evaluations for

your session.

Getting Ready for a Session - Handouts

• Print and copy all of the handouts in the guide. • Order handouts from National Diabetes

Education Program or the organizations listed. – Allow time for delivery.

• Worksheets can be edited to meet the needs of your group.

Evaluating New Beginnings

• Session tracking tool

• Participant evaluation form

• Outcome evaluation

Building Trust and Maintaining Privacy

• New Beginnings sessions should be a safe space that is: – Free of judgment – Private

Building Trust and Maintaining Privacy

• During the first session ask the group to establish ground rules that cover:– Sharing information– Respect– Privacy– Other issues

New Beginnings Promotional Tools

• Flyer

• Postcard

• Recruitment letter

• Slides

For More Information about New Beginnings visit: www.cdc.gov/diabetes/ndep/new-

beginnings.htm

Scan this code with your mobile device to go to the New Beginnings website.

For more information call 1-800-CDC-INFO (800-232-4636) TTY 1-(888) 232-6348

Or Visit www.cdc.gov/info

To order resources, visit www.cdc.gov/diabetes/ndep