Reflection tools – support for patient learning in group education

This qualitative study describes how reflection can be supported by using reflective tools in group education in type 2 diabetes. The changed conditions for living with a long-term illness may lead to increased anxiety and new demands that affect one's current life situation. The didactic model, 'The challenge – to take charge of one's life with long-term illness', has been developed into 'Taking responsibility in life with type 2 diabetes – a model for group education in primary care'. Specialized diabetes nurses and dieticians received training, a manual and continuous guidance in applying the model. Reflection diaries, notes and interviews both from the patients and the caregivers were analyzed using a phenomenological hermeneutic method. The results show that using images as reflective tools engages thoughts and feelings in a way that appears to be important for one's learning in life with a chronic illness. The images contribute to allowing a distance from one's situation, actions, thoughts and feelings, which seems fruitful for investigating and discovering new 'things' about oneself. With the support of reflective tools and guiding questions, reflection is led to a deeper existential level where both caregivers and patients contribute by asking questions that support the reflection process.