Overcoming Barriers to Change: Insulin Pump Transition. Korey K. Hood, PhD Professor & Staff Psychologist Stanford University School of Medicine

Transcription

1 Overcoming Barriers to Change: Insulin Pump Transition Korey K. Hood, PhD Professor & Staff Psychologist Stanford University School of Medicine 1

2 Topics Reviewed Change is hard for everyone and can be harder for people attached to a particular way of managing diabetes One of the many roles of the healthcare provider (HCP) is to advise the person with diabetes (PWD) on current options for managing diabetes At times, a role is to assist with and facilitate change from one way of managing to another, as is the case now with the Animas insulin pump Thank you for reviewing this program and helping make the transition from the Animas insulin pump to another pump 2

3 Change is Hard Many theories (e.g., stages of change, self-determination) about how and why people change Number of theories on why people adopt or change to new technologies Fairly consistent themes are: Change happens less than people and their HCPs would like People often underestimate how hard it will be to change Many other factors contribute to changing behaviors that affect health (e.g., health beliefs, access to care, family factors) 3

4 Change is Hard Change is tied closely to decision making Change is observed (or not) when a decision has been made, either actively or passively Most people make decisions or act for one of two reasons rational or emotional Emotional reasons can be it feels good or I had a gut feeling Rational reasons can be this will help me perform better at work or this is good for me Consider the example of a person deciding to exercise 4

5 5 Common Barriers to Change Inertia maintain the status quo either knowingly or not Knowledge unsure of need for change or how to do it Skill deficits may be interested in change, but the set of skills to make the change is missing Skepticism belief that the change is not necessary or uncertainty that it will make a difference Too difficult may be interested in change, but it seems too difficult to change **often similar barriers for HCPs 5

6 Barriers to Device Use Tanenbaum ML, Hanes SJ, Miller KM, Naranjo D, Bensen R, Hood KK. Diabetes device use in adults with type 1 diabetes: barriers to uptake and potential intervention targets. Diabetes Care Feb;40(2): doi: /dc PMID:

7 HCP PWD Mismatch Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, Hood KK. Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use. J Diabetes Sci Technol May;11(3):

8 Barriers Summarized Common to be worried about how a device (like an insulin pump) will look and feel on the body Adults and children are similar in this, but children and teens are more socially worried about devices HCPs often first aim to increase knowledge, but that is not always a barrier for people Recommendation: briefly assess barriers to change and then develop treatment plan accordingly 8

9 Questions to Assess Barriers to Change Everyone who starts a new device or changes to a different one thinks about what it will be like using this new device. What have you thought about using a new insulin pump? What worries you about switching to a new pump? What do you think is going to be different? What will be the same? 9

10 Categorize Responses Most of the perceived barriers will fall into one of 5 common barriers Inertia maintain the status quo either knowingly or not Knowledge unsure of need for change or how to do it Skill deficits may be interested in change, but the set of skills to make the change is missing Skepticism belief that the change is not necessary or uncertainty that it will make a difference Too difficult may be interested in change, but it seems too difficult to change **often similar barriers for HCPs Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, Hood KK. Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use. J Diabetes Sci Technol May;11(3):

11 Categorize Responses If answers to questions use words such as I don t know or questions about technical aspects What s the difference between the pumps? KNOWLEDGE or SKILL DEFICIT barriers If answers to questions use words such as I m worried it will not work as well. or Seems like a lot of new things to learn. SKEPTICISM or TOO DIFFICULT barriers If answers primarily focus on not wanting to change but unsure why, likely INERTIA is the main barrier 11

12 Knowledge or Skill Deficits Reassure that it is going to be okay and the new pump will work very well for you (and family) Encourage to read about new pump online and offer to answer questions about it Schedule diabetes education or pump training to bolster skills and try new pump Give concrete examples of how it will still work well (e.g., can still give insulin from pump while at work or school; the size is the same) 12

13 Skepticism or Too Difficult Reassure that it is going to be okay and the new pump will work very well for you (and family) Help them find videos online or information in clinic about other people using particular pump Teach them problem solving (or coordinate a teach with the diabetes educator to learn problem solving) Offer to do a slow start where they wear new pump without insulin to get used to how it feels and works 13

14 Inertia Hardest barrier to deal with Reassure that this change will not affect how diabetes is managed while at the same time offering them new options Review list of different or new features and note how they could be helpful to daily management Warm up to the transition and consider getting the pump, taking it out of the box, and testing it over the course of days or weeks, then transition 14

15 Problem Solving Skill that can be learned and improved American Association of Diabetes Educators, American Diabetes Association, and many other programs feature problem solving and goal setting as critical skills 3 step process of: 1. Identify problem (e.g., don t know how to use pump) 2. Brainstorm solutions (e.g., education, slow start, play with pump before starting, practice) 3. Monitor progress and adapt plan (e.g., check-in one week later, try different solution, re-check week later) 15

16 Summary Change is hard, but can be achieved People with diabetes need their HCPs to facilitate transition to new pump Ask and identify barriers to change Encourage slow starts and use problem solving to help with the transition 16

17 For more information visit Become a member and opt in to be notified about our new programs, publications and more! Follow us on to receive timely and important updates about diabetes Subscribe to our YouTube channel to view our clinical videos and webinar chapters 17