Educator challenges using participatory methods in group-based patient education Tue Helms Andersen Science and Research Department, The Danish Diabetes Association, Copenhagen, Denmark, and Nana Folmann Hempler and Ingrid Willaing Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark Abstract Purpose – 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). Design/methodology/approach – Qualitative analysis of observations of eight group-based patient education sessions and seven in-depth semi-structured interviews with 11 educators. Findings – 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. Originality/value – 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. Keywords Participation, Competence, Empowerment, Educational practice, Health education, Diabetes Paper type Research paper Introduction/background In 1986, the Ottawa Charter for Health Promotion (World Health Organisation, 1986) stated that the roles of educators and patients in traditional didactic group-based patient education did not necessarily support patients in changing life habits. It was suggested that we should put an end to the idea of chronic disease as the only decisive element in patients’ lives and begin focussing on quality of life and psychosocial The current issue and full text archive of this journal is available at www.emeraldinsight.com/0965-4283.htm Received 17 July 2013 Revised 20 September 2013 5 November 2013 Accepted 9 November 2013 Health Education Vol. 114 No. 2, 2014 pp. 152-165 r Emerald Group Publishing Limited 0965-4283 DOI 10.1108/HE-07-2013-0032 The authors thank the educators and patients involved in the study for their time. Gitte Engelund from Steno Diabetes Center, Steno Health Promotion Center was the principal investigator of the larger study and provided ideas and support. Annegrete Juul Nielsen provided supervision for the master thesis on which this paper is based. 152 HE 114,2