In my role as a cultural mediator and diabetes navigator over the last five years, I have recognized the need for simple messaging of abstract concepts for patients from all socio-economic backgrounds in order to be meaningful. There are Western concepts that, as a system, we may take for granted. These include “chronic disease”, “prevention”, and “primary care”. In addition, we have a non-trivial number of illiterate and/or indigenous language speakers that also have low numeracy and a completely different concept of time and scheduled appointments.
The idea behind the “Steering Wheel of Self-Management” is to have a visual tool to be used by providers and patients alike. Providers/ educators can teach patients, patients can teach other patients.
Concept of Self
Perhaps the most basic concept I share with patients is the notion of SELF within the patient-centered care model in a clinical setting. Many of our patients come from countries or health systems that discourage patient participation, questions, or self-empowerment. They come to clinic for a “cure” or “fix” from an educated expert. Once they learn there is no “cure” for a chronic condition like diabetes, they may quickly lose interest or feel that it is not within their rights to express misgivings to a doctor. Hence, I developed the idea of the steering wheel as a central metaphor for illustrating control over one’s chronic disease, instead of being a passive recipient of it.
Prevention: Know how to avoid complications by managing YOUR own personal steering wheel according to YOUR life situations.
Concepts of Journey and Time
For many immigrants and refugees, the concept of a long journey or travel is a familiar one. This implies both distance and time in a way that our patients can more easily connect with.
- Conceptual Message: TIME, something managed over time
- Implicit message: Drive your diabetes so it doesn’t drive you
Chronic = continuous: Recognize that your highway and terrain will change over time. Learn to navigate the curves keeping both hands on the your steering wheel.
Steering Wheel Metaphor
Through trial and error during clinical visits and discussions in the lobby, I developed a series of images relating to the one central metaphor that seemed to easily illustrate chronic disease as a tangible concept. Originally I used a stock clip art wheel (later, we developed this original illustration, below) with three spokes to signify the three basic impacts on blood glucose: medication, food and exercise. The two hands on the steering wheel indicating patient empowerment.
- Steering Wheel of Self-Management, the tool to keep a handle on things (your health).
- Steering wheel has 3 spokes or points: Exercise, Food, Medicines, all three used in combination,
- to keep on the road and not drive over the edge or off a cliff.
- Emphasizing it is not just one thing.
Then over time I began to deepen the metaphor to include the “highway of life” and its curves and roadblocks encountered that can affect diabetes management.
Highway is your diabetes or your health in general, there are many curves and stops on the highway.
Practical uses of the steering wheel include a version with text and a pictorial-only version for patients with illiteracy or low literacy. The wheel can be printed out and notes written for patients identifying short term goals in the areas of exercise, nutrition and medication management, and for visualizing a care plan. The wheel image can be sent in mailer reminders, as motivator, to patients.
Steering Wheel with Words
Steering Wheel – Pictures only
Patient feedback has been very positive both in clinic and in community health worker settings. Through the teach-back method, patients have demonstrated a strong grasp of the concept of chronic disease, despite education level. Patients have been able to individualize care plans and select small tangible goals to work on for behavior change.
The Steering Wheel of Self-Management operates under the Creative Commons License Attribution-Noncommercial-No Derivative Works 3.0 United States. You are free to copy, distribute, display this work under the following conditions:
- Attribution: You must attribute the work to EthnoMed, and author Rose Cano.
- Noncommercial: You may not use this work for commercial or for-profit purposes
- Alterations: You may not alter, transform, or build upon this work.
For any reuse or distribution, you must make clear to others the license of this work. Any of these conditions can be waived if you get permission from the copyright holder.