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Therapeutic Education: Proposal for a Theoretical Model Based on the Experiences of the Cuban Diabetes Program

(Rosario García & Orlando Suárez, published by PAHO, 2007)

Full Text (in Spanish, PDF, 100 pp, 3593 Kb; chapter heading translated below for user orientation)
- Preface
- Prologue (text to right)
- Towards the Construction of a Theoretical Model
- From Theoretical Reflexion to Practical Application
- The Cuban Strategy for Diabetes Education
- Scientific Discussion
- Conclusions
- Bibliographical References
Annex 1: Characterization of Research Corresponding to the First Phase of Development
Annex 2: Characterization of Research Corresponding to the Second Phase of Development
Annex 3: Characterization of Research Corresponding to the Third Phase of Development
Annex 4: National Standards for the Development of the Education Program for People with Diabetes, Designed and Evaluated by the National Institute of Endocrinology

PAHO Links
- Newsletter: Chronic Disease Prevention and Control in the Americas
- CARMEN Initiative
- Healthy Eating & Active Living
- Diabetes
- Hypertension
- Cardiovascular Diseases

Other Subregional Initiatives
- Central American Diabetes Initiative (CAMDI)
- Veracruz Initiative for Diabetes Awareness (VIDA Project)
- Institutional Response to Diabetes and Its Complications (IRDC, Caribbean)

Prologue by Prof. Oscar Mateo de Acosta, Dr. Sc.

As is shown in the present work, different sociodemographic events have influenced the population's current health profile, pointing to noncommunicable diseases as a major adult health problem.

Nowadays, therapeutic education for people with this type of disease, as well as for their closest family members, constitutes an important challenge for both research and clinical practice, since the optimal quality of the treatment and quality of life of the people with these diseases depend on their comprehension, skill and motivation—things they need to have in order to handle day-to-day arrangements and self-care—as well as on the capacity of health providers to achieve the necessary level of comprehension, skill, and motivation among the personnel who offer their services.

Of course, this universal assertion is conditioned, as is succinctly pointed out in the present work, by the different approaches, health policies and strategies that are designed in different countries. Nevertheless, there is another barrier that needs to be overcome inside the different health systems and services: acceptance that, given the current development of the person's health/disease process, it cannot always be cured, and that caring implies sharing responsibilities, facilitating comprehension, and negotiating involvement with daily self-care, which imposes the need for a change of approach between addressing acute problems and chronic problems.

Although practically everybody accepts the importance of the educational dimension in promoting health and in preventing and treating diseases, few put it into practice successfully and even fewer have done scientifically rigorous research on which tools are most adequate to improve their efficacy. The result is that we have excellent means of prevention and a therapeutic arsenal to prolong the life years of these patients, but we have not been capable of improving the quality of life of those years—a conflict that emerges in nearly every scientific journal addressing the problem.

Within this framework, the present work has the advantage of providing a new approach and a well-structured product that—from its Introduction onwards—brings the reader up to date on new scientific developments in the area, so as to leave it clearly explained in the following chapters, pointing out precisely the tract scientifically traveled for the construction of the proposed theoretical model—which, in turn, is endorsed by the results obtained in their return to practice and new findings are pointed out for the first time to the international scientific community. Among its principal merits are the following:

• The scientific rigor maintained from the identification of the problem all the way to its practical transformation over the space of 20 years, always consistent with the philosophy and strategy to which it was a party.
• The theoretical enrichment arising from the aforementioned international experience and from an interdisciplinary approach that integrates elements of different medical and social disciplines.
• The systematization and temporal continuity of the study that permitted transition from practice to theoretical generalization, and then returning to practice with the ability to transform it—which constitutes a guarantee of the results obtained and the differential characteristics of this material when we compare it with other products published by prestigious international working groups in therapeutic education.

I cannot finish without going over the personality and career path of the authors of this book, whose training in the field of diabetes started in this institution and who-through their unconditional efforts, honesty, scientific discipline, and dedication to the field of diabetes education-have been able to reach a significant scientific level, recognized nationally and internationally and endorsed by 3 international and 18 national awards.

Given all of the above, I consider that the present book—in addition to compiling the theoretical foundation, applicability, and systematization of a model for therapeutic education—can serve as a guide for its readers to find their own roads in strengthening action aimed at the design, implementation, and evaluation of education programs for people with chronic diseases and—why not?—at any program geared towards educating and empowering people with other types of diseases that require developing their own control abilities.