[Effectiveness and efficiency of ambulatory diabetes education programs. A comparison of specialty practice and general practice]. / Effektivität und Effizienz ambulanter Diabetikerschulungen. Ein Vergleich von Schwerpunktpraxis und Allgemeinpraxis.

BACKGROUND AND OBJECTIVE: The increasing incidence of NIDDM requires adequate proof of the effectiveness and efficiency of out-patient programmes for diabetics. This study aimed at examining which of the two methods may promise the better results under controlled expenses--modifications of the present standardized diabetes education program in the general practice or specifically developed diabetes education programme in specialist diabetes practice. PATIENTS AND METHODS: 75 diabetics took part in the different out-patient diabetes education programmes at one special practice for diabetology or one of seven general practitioner practices, respectively. The self-developed intensive diabetes education programme of the special practice led by two specialists in diabetology and a dietician was compared with the diabetes education programme of the general practices performed by a doctor's assistant. 38 diabetics in eight training groups at the specialist for diabetology and 37 patients in seven training groups at the general practices were instructed. 32 patients in total (18 patients at the specialist practice and 14 patients at the general practices) additionally received an evaluated support programme which addressed psychosocial impediments related to the topics of a structured diabetes therapy. All patients were asked to complete a questionnaire before, right after, 3 and 6 months after the programme. Weight and glycosylated haemoglobin (HbA1c) were measured before, 3 and 6 months after the programme. RESULTS: The mean weight and glycosylated hemoglobin of all groups decreased as expected. However, the patients of the general practices achieved more lasting reduction of these objective parameters. All patients stated impairments of their quality of life, but the patients of the specialist practice felt more impaired. The motivational support programme achieved only few positive results. CONCLUSION: The standardized diabetes education programme of the general practices and the more intensive and expensive diabetes education programme achieved equally valuable results. Regarding time and expenses, the standardized diabetes education programme may be the more efficient method of NIDDM out-patient education.

[Effects of patient education in type II diabetic patients after clinic admission. Results of a 3 month catamnesis after new patient-centered education]. / Schulungseffekte bei Typ-II-Diabetikern nach einem Klinikaufenthalt. Ergebnisse einer dreimonatigen Katamnese nach neuer patientenzentrierter Schulung.

The success of structured teaching programs trying to enable NIDDM patients to carry out effective self-management of their diabetes often does not last very long. Only few type-II-diabetes patients are able to both, control their nutritional behaviour, and maintain metabolic control in the long run. We added therefore a patient-centered motivational support training programme to a regular teaching programme. The underlying hypotheses being that the cognitions of patients with NIDDM frequently cause non-compliant behaviour concerning diet and sports. The motivational training programme aimed at systematic modification of patients' cognitions. 43 type-II-diabetes patients took part in a test of the motivationally supplemented diabetes training. As a result of the training a range of variables such as quality of life, glycosylated haemoglobin, body weight, etc. strongly supported the superiority of the motivational supplemented teaching programme. Unfortunately, effects of the motivational training programme disappeared within three month after completion of the training. These findings suggest that further support is needed to maintain the achieved level of motivation after the training. To address this problem we designed a self-help programme to be worked by the patients themselves whenever metabolic control cannot be maintained.

[Development and outcome of motivational support during inpatient education of insulin-dependent diabetic patients--a pilot project]. / Entwicklung und Ergebnis einer motivationalen Unterstützung bei der stationären Schulung von insulinabhängigen Diabetikern--ein Pilotprojekt.

At the Ulm University Hospital 43 type-1-diabetes patients took part in a structured in-patient diabetes education program during a 12-day hospitalization period. 27 of the patients received an additional motivational support program which addressed psychological and social impediments related to the topics of the structured diabetes education program. 16 patients underwent the structured diabetes education program only. Motivational support aimed at reducing the specifically addressed sociopsychological barriers. Thus, the effects of the structured diabetes education program should be stabilized and an optimal outcome insured. All patients were asked to complete a questionnaire before, right after and 3 months after the program. Glycosylated hemoglobin (HbAlc) was evaluated before and 3 months after the program. Patients who underwent the motivational support program still felt 3 months after completion of the program that metabolic control was important, whereas patients without motivational support did not. Metabolic control--as indicated by measurement of glycosylated hemoglobin--could be maintained in the patient group with motivational support. Although their blood glucose levels had been in the normal range to start with. These encouraging results suggest implementation of a motivational support program into standard diabetes education programs for type-I-diabetes patients.

[Attribution-changing measures in psychotherapy and medicine: theoretical foundation, applications and success]. / Attributionsverändernde Massnahmen in Psychotherapie und Medizin: Theoretische Begründung, Ansatzpunkte und Erfolg.

Attributional changes in psychotherapy and medicine: Theory, application, and success. The treatment of eating disorders and diabetes, of smoking and hypokinesis is closely related to patients' attributions. Non-supporting attributions frequently excuse patients' lack of motivation to change risk behaviors sometimes, as with anorectic behavior, they even underline patients power to control their behavior. Critical experiences leading to patients' non-supporting attributions are reconstructed on the basis of Kelley's (1967) attribution theory; after defining supporting attributions for various diseases and health risks the critical information resulting in these attributions is defined. Corresponding changes in patients' attribution will reduce patients' non-compliance and support success in therapy. Though little research is published on long-term effects of attributional changes, patients' belief in supporting attributions will stabilize therapy success.

[Health diagnosis and health counseling. Traditional risk factors are not in the foreground!]. / Gesundheitsdiagnostik und Gesundheitsberatung. Herkömmliche Risikofaktoren stehen nicht im Vordergrund!

This article reviews the bio-psycho-social factors of health stabilization and health rehabilitation. It is our aim to improve psychology's and general medicine's cooperation in these fields of research and practice. We, therefore, firstly concentrate on the psychosocial factors which improve health diagnosing and health education; we illustrate health education by selectively reviewing illness-related health trainings. Secondly, we discuss health counseling. Again, we concentrate on the improvement of general practitioner's health counseling. On the one hand, this improvement seems possible on the basis of individual bio-psycho-social risk models. Individual bio-psycho-social risk models, on the other hand, only can serve as a basis for individual-centered interventions, but not for population-centered interventions. After reporting various case histories from different doctor-patient-interactions, we demonstrate the application of bio-psycho-social risk models in the individual case. These applications in the general practitioner's office promise to be useful. Nevertheless, general medicine as well as psychology seem to have only minor interest in intensifying their cooperation.

[Physical and social comparisons at admission to therapy: a contribution to the differential diagnosis in obesity]. / Physikalische und soziale Vergleiche bei der Therapieaufnahme: Ein Beitrag zur Differentialdiagnostik bei Adipositas.

Social as well as physical comparison processes of 45 obese participants in a behavioral weight-loss-intervention were confronted to those of 28 obese non-participants. Non-participants were interviewed in general practitioner's offices, participants were interviewed at the beginning and the end of the weight-loss-intervention. Results clearly show that non-participants use standards to compare their body weight which are much harder to realize than participants do. The relevance of these results for the development of a differential diagnosis for the obese is discussed.

[Relation of the family physician to his patient and evaluation of the patient: aspects of willingness to comply?]. / Zuwendung des Allgemeinarztes und Bewertungen des Patienten: Aspekte der Compliance-Bereitschaft?

This study was conducted to examine the influence of general practitioner's behavior (i.e. the patient-centered behavior) on patients' inferences as well as on patient's compliance. We demonstrated in a simulation study as well as in an inquiry of patients in general practice that doctor's competence, interest and sympathy are estimated higher, if the doctor's behavior is patient-centered. Significant single results are reported in respect to patients' knowledge, their inference on the state of the disease and on the convalescence. Patient-centered behavior did not have a direct influence on patients' compliance.

[Behavioral sequelae of long-term self-attributed success and failure: an attribution theory analysis]. / Verhaltensfolgen langandauernder selbstzugeschriebener Erfolge und Misserfolge: Eine Attributionstheoretische Analyse.

Starting from earlier results that self-caused long-term failure improved performance, this experiment tested the effect of "working conditions" as well as successes and failures succeeding the experience of long-term success and long-term failure. 64 subjects participated in recognition tests, composed of 9 tasks (with 42 stimuli each), to be solved within five different experimental sessions. Subjects received false feedback concerning each judgement. The feedback was designed to correspond to Kelley's informational requirements for self-attributions. Results clearly show an impairment of performances within new "working conditions" if successes succeed long-term failure or long-term success. Failure succeeding long-term failure in new "working conditions", on the other hand, improves performance. Different attribution theories' capacity to explain these results is discussed.

[Speech and conviction as determinants of behavior and perception in interactions: an example of physician-patient relations]. / Sprache und Uberzeugung als Verhaltens- und Erlebnisdeterminanten in der Interaktion: Das Beispiel des Arzt-Patient-Verhältnisses.

We report on a simulation study with 72 student subjects as well as on an inquiry of 58 patients on the doctor-patient interaction. We were especially interested in inferences that patients draw from general practitioners' behaviors, i.e., their warmth, their kind of talk, and their embarrassment. The simulation study as well as the inquiry reveal patients' inferences that were highly consistent in 9 (out of 16) dependent variables. Patients' inferences on the state of the disease, on the doctor's competence, interest and warmth, on the doctor's kind of talk and sympathy, all consistently depended on the doctor's behaviors. The psychological as well as medical implications of these results are discussed.

[Social comparison processes in health psychology and psychotherapy]. / Soziale Vergleichsprozesse in Gesundheitspsychologie und Psychotherapie.

Recently, Festinger's (1954) theory of social comparison processes has been "detected" for application in clinical psychology. Patients' social as well as physical comparisons evidently are of high relevance for their starting, participating in, and breaking-off of a (psycho)-therapy. As to our analysis, the availability of physical comparisons, on the one hand, and social comparisons with patients (participating in a group therapy) high in similarity, on the other hand, are of high importance for patients' motivation to successfully end a therapy. Suggesting these results, empirical research supports Festinger's (1954) theory. In the final part of the paper we speculatively apply these results to health counseling. As a consequence of these applications, we expect a growing relevance of the theory of social comparison processes for psychotherapy and health psychology as well.