Diabetes is a pervasive health problem with potentially devastating but preventable consequences. Although technological advances and new treatments have resulted in great optimism for controlling the disease, research indicates that the challenges of diabetes self-management are overwhelming for many. One creative intervention which has beginning empirical support and which seems to be helping many living with diabetes to sustain management of the disease and quality of life is diabetes support groups. Nurse diabetes educators have been frequent facilitators in these groups, yet little is known about how these nurses perceive their role and the strategies they use as well as the kind of enhancers and barriers they experience in working with these groups.
This study attempts to better understand this intervention through an exploration of: (1) the nurse's perception and evolution of her role as facilitator; (2) the strategies used by nurse facilitators in the support group context; (3) the extent to which these strategies varied across individual and group settings; and (4) the enhancers and barriers that nurse facilitators experience in attempting to use these strategies in the context of a diabetes support group.
This study used a descriptive exploratory design using in-depth individual interviews and a group interview. The facilitators interviewed described the facilitator role as involving four major aspects: (1) a philosophy of shared authority and group ownership; (2) a conception of diabetes as a highly complex disease interconnected with all aspects of one's life; (3) a focus on quality of life; and (4) a recognition that perfectionism is neither possible nor desirable in managing diabetes. Strategy types identified by the nurse facilitators were: connecting; exchanging information; managing group dynamics; and promoting problem-solving.
This research is critical to increasing understanding of the nature of nurse diabetes support group facilitator role and to contributing an inventory of strategies that nurses use in group settings with clients. Theory implications include that the descriptive model devised will increase the understanding of linkages between facilitator role, strategies, and outcomes. Research implications include the need for quantitatively testing facilitator strategies and linking support group participation with outcomes. In addition, exploring effective group strategies with vulnerable populations is important to decrease health disparities.
