2012 Annual Conference

Hughes, Lynne

University of the Incarnate Word, San Antonio, TX

As practicing PTs and PTAs, we are doing well in addressing the cognitive and psychomotor domains needed to influence behavior change but we can improve in addressing the affective domain of the individual. Cognitive mapping is a one tool that can be used to develop a collaborative relationship with our patients/clients to investigate what their thoughts, feelings, beliefs, needs, and fears may be regarding the change needed. We can use this information to then help guide the patient/client in developing change talk that identifies a specific behavior change, the willingness to change, and the ability to make the change. This method demonstrates a paradigm shift from the traditional paternalistic model of telling the patient/client what to do toward developing a trusting partnership to create a plan to modify behavior.

Sixteen adults with type 2 diabetes consented and completed an interview at the time of diagnosis and 6 months later.

Interviews were conducted using a cognitive mapping technique. Participants were asked to write words or phrases in response to the question, “When you think about living with diabetes, what comes to mind?” These quotes were arranged on a poster board with relationships indicated by grouping or arrows, thus generating a cognitive map. From the cognitive maps, concepts were identified, grouped into clusters, and condensed into categories. The 6 month follow up maps were also coded for polarity and change talk. In addition, each participant completed a questionnaire that included demographics, lifestyle habits, diabetes management practices, and biometrics. Comparisons of quantitative measures were statistically examined over time and associations were sought among categorical data.

At the time of diagnosis, persons most frequently wrote quotes in the need to and concerns categories while at 6 months they wrote of coping and change. This paradigm shift in the overall thinking of the participants was observed in the concepts, clusters, and categories as well as from negative to positive quotes over time. Persons who were college educated were more likely to generate change talk (need to, have to, coping) initially and more likely to produce a map with a positive tone at 6 months. Six months after diagnosis, a greater number of participants were performing more activities, chores, diet changes and less daily monitoring of blood glucose. The majority of participants lost weight (87.5%) and showed a decrease (93.3%) in their A1C yet more than half did not attend a diabetes education class.

Cognitive mapping was shown to effectively reveal the issues and perceptions of people newly diagnosed with type 2 diabetes and at the 6 month follow-up. Cognitive mapping may be used as a tool by health care practitioners to reveal a holistic portrait of person’s thoughts, feelings, beliefs, needs, and fears about living with chronic disease. In addition, cognitive mapping can reflect a person’s desire, ability, and readiness to change through the presence of change talk. Therefore, cognitive mapping may be used repeatedly over time to help tailor a behavior change program to an individual.