Educator challenges using participatory methods in group-based patient education

Tue Helms Andersen (Science and Research Department, The Danish Diabetes Association, Copenhagen, Denmark)
Nana Folmann Hempler (Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark)
Ingrid Willaing (Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark)

Health Education

ISSN: 0965-4283

Publication date: 28 January 2014



The purpose of this paper is to explore educators’ experiences of putting a participatory and patient-centered education model, “The Health Education Juggler,” into practice after having attended a one-day seminar. The model consists of four educator roles in participatory group-based patient education in chronic illness: embracer (takes care of the group), facilitator (generates dialogue and participation), translator (communicates professional knowledge) and initiator (motivates action in patients).


Qualitative analysis of observations of eight group-based patient education sessions and seven in-depth semi-structured interviews with 11 educators.


Educators find it difficult to include disease-specific knowledge when working with a flexible patient-centered approach. They tend to stay in the role they find most comfortable during education sessions (most often that of embracer), rather than adopting new and more challenging roles in the teaching process. Educators theoretically understand the role of facilitator, but they do not know how to perform in this role in practice. The ability to juggle all educator roles depends on the ability to master each.

Practical implications

The Health Education Juggler model shows promise in promoting participation and patient-centeredness and as a reflection tool for educators and an analytic tool for quality assessment of patient education. These findings support further development of model use.


This model of educator roles in group-based patient education in chronic illness provides a new approach to patient education. It indicates the need for various professional competencies among educators to provide patient-centered education in a flexible way, with a strong focus on patient-identified problems and challenges, social learning processes and generation of internal motivation in patients.



Helms Andersen, T., Folmann Hempler, N. and Willaing, I. (2014), "Educator challenges using participatory methods in group-based patient education", Health Education, Vol. 114 No. 2, pp. 152-165.

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