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A Novel Approach to Improving Access to DSME

Jun 06, 2018

Joanne-Duncan-Carnesciali

About the Author:

Joanne Duncan-Carnesciali, EdD, CDE®, ACSM RCEP®, CHES®, NBC-HWC is the principal of Choose2Empower Behavioral Health Consultants. As a CDE, American College of Sports Medicine Registered Clinical Exercise Physiologist, Certified Health Education Specialist and nationally board-certified health and wellness coach in possession of a doctorate in health education, master’s degrees in diabetes education and management and exercise science and health promotion, Joanne is uniquely prepared to deliver evidence-based health interventions for healthy populations and populations living with chronic illness.


It is common knowledge that type 2 diabetes is an epidemic in the United States. Furthermore, the low number of healthcare professionals qualified to deliver diabetes self-management education and support (DSMES) contributes to the challenge of access for the populations that need it most — populations of low socioeconomic status and ethnic minority groups.

The importance of quality DSMES was made evident with the introduction of the Access to Quality Diabetes Education Act of 2015 (H.R. 1725/S.1345) by Representative Ed Whitfield (R-KY) in May 2015. This act directed the Comptroller General to study the barriers to DSMES services that exist for Medicare beneficiaries with diabetes. Additionally, it tasked the Director of the Agency for Health Care Research with developing a series of recommendations on effective outreach methods to educate physicians, healthcare providers and the public about the benefits of diabetes self-management education.


The study revealed that a need exists for CDEs to become more knowledgeable regarding the centrality of the AADE7 Self-Care BehaviorsTM framework in the delivery of DSMES.


This act, among other factors, formed the basis of the study “An Evaluation of a Diabetes Self-Management Education (DSME) Intervention Delivered Using Avatar-Based Technology: Certified Diabetes Educators’ Ratings and Perceptions.” The evaluation study investigated the perception that certified diabetes educators’ (CDEs) have a culturally appropriate e-health intervention. This study revealed the potential that an e-health intervention, grounded in evidence-based health behavior theories, has in reducing barriers to accessing DSMES. 

Common evidence-based theories and frameworks that were utilized in the investigation included the AADE7 Self-Care Behaviors, the social cognitive theory, the empowerment approach, brief action planning, motivational interviewing and the transtheoretical model.

While it is highly encouraging that the study revealed healthcare professionals in possession of the CDE credential had favorable perceptions and ratings of the avatar-based intervention, the study also revealed that a need exists for CDEs to become more knowledgeable regarding the centrality of the AADE7 framework in the delivery of DSMES. This was made evident in comments pertaining to the avatar, which criticized the information as being too basic and too simple.

It is high time for CDEs across the various healthcare professions to further connect and acknowledge the strength, utility and importance of the AADE7 framework as it provides a common language for communication among CDEs. As articulated by AADE, the AADE7 provides consistent measures for conducting research to provide evidence for policymakers advocating for healthcare policy.

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