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Overcoming Barriers to Change: Insulin Pump Transition

Korey K. Hood, PhDProfessor & Staff PsychologistStanford University School of Medicine

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• Change is hard for everyone and can be harder for people attached to a particular way of managing diabetes

• One of the many roles of the healthcare provider (HCP) is to advise the person with diabetes (PWD) on current options for managing diabetes

• At times, a role is to assist with and facilitate change from one way of managing to another, as is the case now with the Animas insulin pump

• Thank you for reviewing this program and helping make the transition from the Animas insulin pump to another pump

Topics Reviewed

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Many theories (e.g., stages of change, self-determination) about how and why people change

Number of theories on why people adopt or change to new technologies

Fairly consistent themes are:• Change happens less than people and their HCPs would like

• People often underestimate how hard it will be to change

• Many other factors contribute to changing behaviors that affect health (e.g., health beliefs, access to care, family factors)

Change is Hard

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Change is tied closely to decision making

Change is observed (or not) when a decision has been made, either actively or passively

Most people make decisions or act for one of two reasons – rational or emotional• Emotional reasons can be “it feels good” or “I had a gut

feeling”

• Rational reasons can be “this will help me perform better

at work” or “this is good for me”

Consider the example of a person deciding to exercise

Change is Hard

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Inertia – maintain the status quo either knowingly or not

Knowledge – unsure of need for change or how to do it

Skill deficits – may be interested in change, but the set of skills to make the change is missing

Skepticism – belief that the change is not necessary or uncertainty that it will make a difference

Too difficult – may be interested in change, but it seems too difficult to change

**often similar barriers for HCPs

5 Common Barriers to Change

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Barriers to Device Use

Tanenbaum ML, Hanes SJ, Miller KM, Naranjo D, Bensen R, Hood KK. Diabetes device use in adults with type 1 diabetes: barriers to uptake and potential intervention targets. Diabetes Care. 2017 Feb;40(2):181-187. doi: 10.2337/dc16-1536. PMID: 27899489

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Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, Hood KK. Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use. J Diabetes Sci Technol. 2017 May;11(3):484-492.

HCP – PWD Mismatch

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• Common to be worried about how a device (like an insulin pump) will look and feel on the body

• Adults and children are similar in this, but children and teens are more ‘socially’ worried about devices

• HCPs often first aim to increase knowledge, but that is not always a barrier for people

• Recommendation: briefly assess barriers to change and then develop treatment plan accordingly

Barriers Summarized

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“Everyone who starts a new device or changes to a different one thinks about what it will be like using this new device. What have you thought about using a new insulin pump?”

“What worries you about switching to a new pump?”

“What do you think is going to be different? What will be the same?”

Questions to Assess Barriers to Change

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Categorize Responses

Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, Hood KK. Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use. J Diabetes Sci Technol. 2017 May;11(3):484-492.

Most of the perceived barriers will fall into one of 5 common barriers

Inertia – maintain the status quo either knowingly or not

Knowledge – unsure of need for change or how to do it

Skill deficits – may be interested in change, but the set of skills to make the change is missing

Skepticism – belief that the change is not necessary or uncertainty that it will make a difference

Too difficult – may be interested in change, but it seems too difficult to change

**often similar barriers for HCPs

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If answers to questions use words such as “I don’t know” or questions about technical aspects – “What’s the difference between the pumps?”KNOWLEDGE or SKILL DEFICIT barriers

If answers to questions use words such as “I’m worried it will not work as well.” or “Seems like a lot of new things to learn.”SKEPTICISM or TOO DIFFICULT barriers

If answers primarily focus on not wanting to change but unsure why, likely INERTIA is the main barrier

Categorize Responses

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Knowledge or Skill Deficits

• Reassure that it is going to be okay and the new pump will work very well for you (and family)

• Encourage to read about new pump online and offer to answer questions about it

• Schedule diabetes education or pump training to bolster skills and try new pump

• Give concrete examples of how it will still work well (e.g., can still give insulin from pump while at work or school; the size is the same)

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• Reassure that it is going to be okay and the new pump will work very well for you (and family)

• Help them find videos online or information in clinic about other people using particular pump

• Teach them problem solving (or coordinate a ‘teach’ with the diabetes educator to learn problem solving)

• Offer to do a slow start where they wear new pump without insulin to get used to how it feels and works

Skepticism or Too Difficult

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• Hardest barrier to deal with

• Reassure that this change will not affect how diabetes is managed while at the same time offering them new options

• Review list of different or new features and note how they could be helpful to daily management

• Warm up to the transition and consider getting the pump, taking it out of the box, and testing it over the course of days or weeks, then transition

Inertia

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Skill that can be learned and improved

American Association of Diabetes Educators, American Diabetes Association, and many other programs feature problem solving and goal setting as critical skills

3 step process of:1. Identify problem (e.g., don’t know how to use pump)

2. Brainstorm solutions (e.g., education, slow start, play with pump before starting, practice)

3. Monitor progress and adapt plan (e.g., check-in one week later, try different solution, re-check week later)

Problem Solving

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Summary

• Change is hard, but can be achieved

• People with diabetes need their HCPs to facilitate transition to new pump

• Ask and identify barriers to change

• Encourage slow starts and use problem solving to help with the transition

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