Optimizing patient education for people with obesity: possible use of the autobiographical approach.

OBJECTIVE: To review recent results of the current approaches to the education of obese people, focusing on the motivation for healthy behaviors, and to present the narrative-autobiographical approach as a possible tool in the education of obese people. METHODS: Our overview will necessarily be partial, and limited to some studies that succeeded in improving the motivation for healthy lifestyles in people with overweight or obesity. We will also describe the use of the autobiographical approach in the "Io-muovo-la-mia-vita" project. RESULTS: Many studies have induced relevant behavioral changes, mainly by using intensive interventions. Weight loss maintenance has been difficult and usually has required pro-active follow-up interventions. The use of self-writing may allow overweight and obese people to reveal their inner feelings to themselves and to peers, and may reinforce their motivation for self-care. CONCLUSIONS: The association of weight loss with intensive interventions, and the need for follow-up pro-active interventions to maintain results make one wonder whether the inner motivation of participants is usually fostered as recommended. PRACTICE IMPLICATIONS: The narrative-autobiographical approach appears to be a proper way to patient centered care, but for an effective practice, the human and relational attitudes of healthcare professionals should be integrated with specific educational skills.

The narrative-autobiographical approach in the group education of adolescents with diabetes: a qualitative research on its effects.

OBJECTIVE: To introduce a narrative-autobiographical approach in the care and education of adolescents with type-1 diabetes and observe the effects of this novel approach on adolescents' self-awareness, concern for self-care, and well-being. METHODS: Ninety-four adolescents with type-1 diabetes attending one 9-day summer camp in 2004, 2005, or 2006 participated in structured daily self-writing proposals on diabetes, integrated with daily interactive self-management education. After some months, we sent participants interview-like questionnaires, and two independent researchers performed a qualitative analysis of the 50 answers that were mailed back. RESULTS: Writing about the discovery of diabetes was, for many, a stressful experience, but with a strong liberating effect. One relevant point was change, which occurred: (a) in the perception of self; (b) in the relationship with others; (c) in the relationship with the disease. CONCLUSIONS: The integration of autobiography in diabetes camps, by adding the value of sharing individual stories to the liberating power of self-writing, can allow the adolescents to overcome their feelings of diversity, and can initiate several changes reflecting increased self-efficacy, maturity, acceptance of the disease and responsibility in self-management. PRACTICE IMPLICATIONS: Self-writing is feasible and well accepted, and provides healthcare professionals a proper way to patient-centered care.