Diabetes education - International Diabetes Federation

Diabetes views
The art of assisting discovery
Margaret McGill
is Manager of
the Diabetes
Centre, Royal
Prince Alfred
Hospital,
Australia. She is
Chair of the IDF
Consultative
Section on
Diabetes
Education and
a Senior IDF
Vice-President.
Different learning theorists and developmental psychologists
have come to different conclusions about the way children
develop intellectually. Some believe that it is a smooth and
continuous process; others believe that children develop in
a more disjointed manner, in a series of relatively stable
stages. The continuous development theory holds that as
children get older, they constantly add new lessons and
skills on top of old lessons and skills. In the staged development
models (Jean Piaget’s cognitive-developmental stage
theory, for example), children seem to develop chunks of
abilities and to experience events at certain times in life.
Both groups are no doubt correct. While it is true that
development is a continuous and lifelong process, it is
also true that there are stages to growth, and that developments
occur at given times throughout life. The article by
Barbara Anderson highlights the importance of considering
children’s developmental issues in order to reconcile
the inevitable conflicts that arise between normal child
development and the complexities of managing diabetes.
Educators must be able to identify potential challenges
and to formulate solutions throughout childhood and
adolescence. It is important to work collaboratively with
young people and their families to prioritize education
and treatment options, breaking down positive behaviour
changes into small manageable steps to promote consistent
and ongoing success.
The relevance to adult diabetes education of such developmental
models and the approaches to learning that
are derived from them, both for people with the condition
and diabetes educators, is reflected throughout this
special issue. The constructivist principles of Piaget and
Vygotsky value developmentally appropriate facilitatorsupported
learning, where the learner stands at the centre
of the educational process. Malinda Peeples and her
co-authors describe the shortcomings in understanding
among many medical healthcare providers of how best
to approach the issues surrounding self-care. The authors
advocate a person-centred approach to diabetes education
which incorporates recognition of the critical role of
psychosocial factors.
Line Kleinebreil’s report on the application of new technologies
in diabetes education demands an expanded
view of constructivist principles, taking into account
recent advances in information technology – which are
increasing our potential for communication and the ability
to store a variety of types of data. Huge benefits can be
derived from a ‘communal constructivism’ where learners
and educators become actively involved in creating
knowledge that will benefit other learners. In this model,
people with diabetes and diabetes educators will not simply
complete a course, but instead leave their own mark
on its development, on its materials, and on the subject
itself. The IDF Diabetes Education Modules provide a
nice example. Since their launch last year, the Modules
have been morphing into region- and community-specific
tools as they are used in diverse settings.
Discovery learning is based on the constructivist approach.
When people practise discovering for themselves, they
learn in a way that makes information more readily viable
in problem-solving: we ‘learn by doing’. In the words of
an ancient Chinese proverb: tell me and I will forget; show
me and I may remember; involve me and I will understand.
In the multidisciplinary courses described by Ta Van Binh
and Le Quang Toan, the learners – Vietnamese doctors
and nurses aiming to enhance their diabetes care skills
– build their knowledge by exploring and manipulating
objects (glucometers), grappling with problems (preparing
plans for education on preventing hypoglycaemia
and sick-day management) and performing experiments
(presenting to the rest of the group and later taking their
newly acquired skills into the community).
There is evidence that discovery learning is less effective
for ‘beginners’ than direct instruction. Clearly, early
learners need some direct instruction first before being
able to apply what they have learned. But it seems
equally clear that education for educators that is based
on an eclectic constructivist approach will reflect the
experiences of people with diabetes as they construct
and apply knowledge on the road to becoming experts
in living with their condition.
November 2007 | Volume 52 | Special Issue