Health care interventions, sense-making and behavior change through transformative learning among health care providers and their clients with diabetes.

摘要

The purpose of this mixed-methods study was to examine the ways that adults with diabetes mellitus and their professional health care providers (HCPs) self-reported a transformation in the way they socially constructed and understood the meaning of an innovative intervention to manage diabetes mellitus, and, in turn, the extent to which changes in selected behaviors and selected biometric client measures were related to the lived experience of the intervention. This longitudinal, descriptive study consisted of 7 client-HCP dyad case studies; used phenomenography and descriptive statistics, and was based on a framework of transformative learning occurring within the context of a series of encounters that comprised an educational intervention program conducted by a health care provider (HCP) in interaction with a learner (client).;The study's main questions asked how clients with diabetes and their HCPs separately self-reported making sense of a teaching-learning experience as part of a diabetes educational intervention, and in what ways did this relate to their individual, behavioral choices and to progression of clients' disease over a 4-month period.;The setting was 3 Midwestern, U.S. medical practice offices where data were collected during summer and fall of 2009. The study's non-probability sample included 3 HCPs and 7 clients, all selected via chain purposive sampling.;Clients' self-measured, numerically represented, visually depicted, blood glucose patterns; clients' numerically labeled glycemic control levels (HbA1c); and client-HCP conversation encounters all combined to serve as the basis for most participants realizing a sense of surprise and increased awareness about certain physiological parameters of clients' disease. These were linked to behavioral changes and transformative learning occurring with 4 out of 5 clients and 3 out of 3 HCPs. Glycemic control improved in 4 out of 5 cases, while the mixed nature of measured glycemic variability changes suggests that further research is warranted.;Key words. Type 2 Diabetes, Type 1 Diabetes, Phenomenography, HbA1c, Blood Glucose, SMBG, Transformative Learning, Behavior Change, Education, Mixed Methods.