Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Theoretical mapping of SMART programs: A quality improvement tool (#104)

Sophie McGough 1 , Rebecca Flavel 1 , Natasha Watson 1 , Kristen De San Miguel 1 , Emma Adams 1
  1. Diabetes WA, Subiaco, WA, Australia


An empowerment philosophy underpinning chronic condition self-management support relies on a program curriculum which is based on psychology theories that promote informed choice.1 Effective facilitator behavior is essential in an empowerment approach for self-management outcomes to be achieved.2 Diabetes WA undertook a quality improvement process to ensure the SMART programs were in line with this empowerment philosophy.


To use an evidenced based tool to assess existing group education programs for social learning theory constructs and provide guidance for their adaptation within a quality improvement process.


Program curriculums contained within the Diabetes WA SMART Series (MeterSmart, FootSmart, MealSmart, CarbSmart and ShopSmart) were assessed by trained DESMOND (Diabetes Education Self-Management for Ongoing and Newly Diagnosed) program facilitators using an adapted version of the Analysis System for Self-Efficacy Training (ASSET) tool.3 Facilitator delivery was assessed using the DOT tool to measure participant versus educator talk time as an indicator of client centred care.2


All programs required significant changes to the curriculum to ensure all four self-efficacy constructs were utilised to promote empowerment. Aims and objectives were revised to better represent the empowerment approach and the Diabetes Empowerment Scale (DES-SF) added as an evaluation measure.4 All revised programs achieved educator talk time which is comparable to the quality standards set by DESMOND.1


DESMOND facilitators at Diabetes WA identified the need to improve the SMART programs to fit with their empowerment philosophy of care. All were able to use the adapted ASSET tool as a guide to assess and modify program curriculum. It improved their understanding of social learning theory and enhanced their facilitation skills to include a variety of techniques to promote participant self-efficacy. As a result of this quality improvement activity a SMART series training program, curriculum and QD pathway will be developed for external providers.


  1. 1. Davies MJ, Heller S, Skinner TC et al. Effectiveness of the diabetes education and self-management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes. cluster randomised controlled trial. BMJ 2008;336:491
  2. 2. Skinner TC, Carey ME, Cradock S et al. 'Educator talk' and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial. Diabet. Med. 2008;25:1117-1120.
  3. 3. Zinken KM, Cradock S, Skinner TC. Analysis system for self efficacy training (ASSET). Patient education and counselling. 2008;72(2):186-193.
  4. 4. Anderson RM, Fitzgerald JT, Gruppen LD et al. The diabetes empowerment scale-short form (DES-SF). Diabetes Care 2003;26(5):1641-1642