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Purpose: The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered., Methods: An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed., Results: Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA1c was the most frequently employed outcome measure, with little, if any, description of the interventions., Conclusions: Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

PURPOSEIn this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories.METHODSThe vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories.RESULTSBoth our vision and our theoretical assumptions should be articulated, discussed, debated, and studied.CONCLUSIONSDiabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education. [ABSTRACT FROM PUBLISHER]

PURPOSE: This article provides an overview of adult learner characteristics, with an emphasis on those characteristics studied in diabetes patient education research. METHODS: A selected review of the conceptual and research literature on general adult education and adult learning was conducted, with particular attention to diabetes patient education studies. RESULTS: Characteristics reviewed included learning styles, literacy level, age/aging, ethnicity or culture, gender, and knowledge. Studies of the learning style of group vs individual education indicated some positive benefits for group learning; questions remain about optimal size or periodicity. Studies evaluating the benefits of culturally specific interventions for diabetes management have yielded some information. Characteristics related to gender and age have been studied, but often in pilot or feasibility studies without the power to answer the study questions. CONCLUSIONS: There continue to be many gaps in knowledge related to adult learner characteristics in diabetes education. Lessons from both general adult learning literature and patient education literature from other cbronic diseases should be evaluated and incorporated. The complexities of these learner characteristics create challenges in designing studies. However, evidence to support the need for effective educational interventions is of great importance for implementing change in health care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). Methods A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. Results Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. Conclusions This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members. Methods Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment. Results Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health–related quality of life. Conclusions Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health–related quality of life. However, strategies for sustaining improvements are needed. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to examine the characteristics of the Spanish-language diabetes self-efficacy scale (DSES-S) and the English-language version (DSES). Methods This study consists of secondary data from 3 randomized studies that administered the DSES-S and DSES at 2 time points. The scales consist of 8 Likert-type 10-point items. Principal component analysis was applied to determine if the scales were unitary or consisted of subscales. Univariate statistics were used to describe the scales. Sensitivity to change was measured by comparing randomized treatment with control groups, where the treatment included methods designed to enhance self-efficacy. General linear models were used to examine the association between the scales and the 8 medical outcomes after controlling for demographic variables. Results Principal component analysis indicated that there were 2 subscales for both versions: self-efficacy for behaviors and self-efficacy to manage blood levels and medical condition. The measures had similar means across the 3 studies, high internal consistent reliability, values distributed across the entire range, and they showed no evidence of floor effects and little evidence of ceiling effects. The measures were sensitive to change. They were associated with several health indicators and behaviors at baseline, and changes were associated with changes in health measures. Conclusions The self-efficacy measures behaved consistently across the 3 studies and were highly reliable. Associations with medical indicators and behaviors suggested validity, although further study would be desirable to compare other measures of self-efficacy for people with type 2 diabetes. These brief scales are appropriate for measuring self-efficacy to manage diabetes. [ABSTRACT FROM AUTHOR]

The article presents a study which describes a school-based health program training at- risk youth to become diabetes self-management coaches for family members with diabetes. Family medicine residents have partnered with the San Francisco Bay Area high schools for the health program. The impact of the program on the diabetes knowledge and psychosocial assets of at-risk youth is outlined.

The article presents a study aimed at determining the efficacy and feasibility of a generic chronic disease self-management program for people with type 2 diabetes. Adults with type 2 diabetes who are under the U.S. National translation study of Stanford Chronic Disease Self-Management Program (CDSMP) participated in the study. Results demonstrated the efficiency for lowering A1C among people with A1C above 7% and for enhancing health status for people with diabetes.

PurposeThe purpose of this study was to implement and evaluate a care delivery model integrating the registered nurse–certified diabetes educator into the patient-centered medical home to assist in achieving positive clinical and cost outcomes in diabetes care.MethodsA 1-group pretest-posttest research design was used. Patients were recruited from 2 patient-centered medical home designated/nominated primary care offices. Inclusion criteria were as follows: diagnosis of type 1 or type 2 diabetes, aged 18 to 80 years, A1C ≥ 8%, English speaking, and no diabetes education within 6 months. There were 34 participants (men, n = 22; women, n = 12) with a mean age of 53.24. The intervention incorporated an assessment, 4 patient-centered monthly group sessions, and 4 individual follow-up sessions. Study measures included program surveys, participation and satisfaction rates, Healthcare Effectiveness Data and Information Set attainment rates, and the following physiologic measures obtained from the medical record: A1C, fasting blood glucose, LDL, urine microalbumin, blood pressure, retinal eye exam, and body mass index. Cost-effectiveness measures included program costs, performance incentives, revenue, provider time saved, and patient health care utilization.ResultsPaired-samples t tests identified significant improvements in A1C, fasting blood glucose, and LDL. Patients and providers were highly satisfied with the program. Cost-benefit analysis revealed a net pretax program benefit.ConclusionsResults of the study indicated that integrating the registered nurse–certified diabetes educator in the patient-centered medical home improves clinical outcomes and is cost-effective. Diabetes education and support are integral components of diabetes management. [ABSTRACT FROM PUBLISHER]

PurposeThe purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness.MethodsVarious recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 ± 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (α = .05).ResultsFollowing the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy.ConclusionsA systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy. [ABSTRACT FROM PUBLISHER]

Diabetes educators use theories all the time, even if they are not aware of it. To teach, one must have some assumptions about how people learn and what constitutes effective teaching. The purpose of this article is to help diabetes educators interested in research and evaluation choose appropriate theories. The article will review the 4 purposes of theories, that is, description, explanation, prediction, and control, as well as the degree to which a theory has been articulated and elaborated. The importance of a theory’s personal resonance, its explanatory power, and its utility will also be examined. The article will also review how to use 1 or more theories at each stage of a research or evaluation project. [ABSTRACT FROM PUBLISHER]

PurposeThe purpose of this study was to evaluate the community-based Chronic Disease Self-management Program (CDSMP) and the Spanish-language version (Tomando Control de Su Salud) programs as delivered in settings along the Texas/New Mexico/Mexico border. The programs had proven effective in randomized trials, and the authors wished to determine if they would be as effective when administered by others to different populations.MethodsThe El Paso Diabetes Association administered the CDSMP and Tomando to 445 persons with chronic illness (two thirds with diabetes) in Texas, New Mexico, and Mexico. Four-month and 1-year outcomes were compared to baseline using t tests of change scores. Regression models were used to test whether baseline demographics and self-efficacy were associated with positive outcomes of the programs.ResultsParticipants showed improvements in health behaviors, health status, and self-efficacy at both 4 month and 1 year. Baseline self-efficacy and 4-month change in self-efficacy were significantly associated with improved 1- year outcomes.ConclusionsThe CDSMP and Tomando are effective when used in settings other than that of the original study for populations other than those for which they were initially developed. [ABSTRACT FROM PUBLISHER]

PURPOSEThis study was conducted to evaluate whether patients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-management behaviors and to determine if movement was related to glucose control.METHODSA cohort of 428 patients with type 2 diabetes participated in a traditional diabetes education program in a large urban center in the Southwest. The sample was predominantly female with less than a high school education, a mean age of 52 years, and a mean duration of diabetes of 7 years. Two interviews were conducted approximately 9 months apart, at 1 to 4 weeks before the educational program and at 6 months after completing it. Blood specimens were collected at each interview to measure hemoglobin A1C (A1C) levels.RESULTSMost of the patients advanced 1 or more stages of change for at least 1 self-management behavior. Those with diabetes for less than 2 years were significantly more likely to advance at least 1 stage of change for diet and exercise than those with diabetes for more than 2 years. Such advancement was significantly associated with a decline in A1C.CONCLUSIONSPatients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-care behaviors. The intervention was more effective for those with a shorter duration of diabetes. [ABSTRACT FROM PUBLISHER]

PURPOSEThe purpose of this article is to describe a culturally competent, dietary self-management intervention designed to improve physiological outcomes, diabetes self-management, and costs of care for high-risk African Americans with type 2 diabetes.METHODSA longitudinal, quasi-experimental design was used to evaluate the effectiveness of the intervention for 23 adult African Americans from a physician practice group in rural South Carolina. The intervention consisted of 4 low-fat dietary education classes, 6 discussion groups, and follow-up. Intervention sessions were provided by a dietitian and nurse case managers and framed as social events; families were encouraged to participate.RESULTSData suggest that the intervention significantly improved fat-related dietary habits, Al C values, fasting blood glucose, and frequency of acute care visits. A trend in reduction of lipids and weight also was observed.CONCLUSIONSCulturally competent dietary self-management provides a meaningful approach to focused diabetes education for rural African Americans. Integrating nursing case management provides an innovative method of addressing the more global issues of delivery of care to underserved rural populations and decreasing the high costs of care. [ABSTRACT FROM PUBLISHER]

PURPOSEthe purposes of this paper are to (1) review the literature on educational interventions for adults with type 2 diabetes; (2) determine what kinds of interventions have been studied; (3) identify which interventions have included cardiac risk factor management; (4) determine how effective these interventions have been on metabolic control, diabetes-related outcomes, and cardiovascular-related outcomes; and (5) make recommendations for further research on combined interventions designed to promote optimal diabetes and cardiac risk factor management in adults with type 2 diabetes.METHODSUsing an integrative literature review approach, 64 studies on diabetes education interventions for adults with diabetes published between 1987 and 1998 were reviewed; 44 met these criteria.RESULTSFew studies included cardiac risk factor management, which should be an integral part of diabetes management. Most studies demonstrated a beneficial effect of education on the management of type 2 diabetes but not cardiovascular risk.CONCLUSIONSIdentifying strategies that promote effective disease management for improved diabetes control and reduction of cardiac events in adults with diabetes is essential. Further intervention studies focusing on the combined management of diabetes and cardiac risk factors are warranted. [ABSTRACT FROM PUBLISHER]

PURPOSEThe purpose of this project was to describe metabolic control, knowledge, and health beliefs of Mexican Americans with type 2 diabetes.METHODSThe study site was Starr County, Texas, a border community located on the Rio Grande River and bordering northern Mexico. Of the total sample of 360 persons, 252 agreed to participate in this intervention study and were randomized either to the treatment group or the control group that waited 1 year to begin the intervention.RESULTSThe majority of individuals were Spanish-speaking females with a mean age of 54 years and a mean diabetes duration of 8 years. For those treated with diet only, males exhibited higher fasting blood glucose levels than females. Gender effects were seen for cholesterol level, with females exhibiting higher levels than males. Males expressed stronger perceptions of control and social support for diet. Bivariate relationships were found between acculturation and diabetes knowledge. The health belief subscales of control and impact on job together explained 16% of the variance in HbAlc values.CONCLUSIONSMales and females held differing beliefs about ability to control their diabetes and degree of social support for diet. The impact of gender differences on ability to integrate diabetes self-care and on effectiveness of diabetes programs has not been determined but should be considered in future research. [ABSTRACT FROM PUBLISHER]

PURPOSEFew culturally competent health programs have been designed for Mexican Americans, a group that bears a disproportionate burden of Type 2 diabetes. In Starr County, a Texas-Mexico border community, investigators designed and tested a culturally competent intervention aimed at improving the health of this target population. The purpose of this article is to describe the development process of this diabetes education and support group intervention.METHODSThe development stages were (1) community assessment, (2) intervention design, (3) selection or development of outcomes, (4) pilot testing, and (5) a randomized clinical investigation.RESULTSFocus group participants identified knowledge deficits regarding diabetes and self-management strategies, and suggested characteristics of an effective intervention for Mexican Americans. Outcome measures included metabolic control indicators, a newly developed knowledge instrument, and an existing health belief instrument. Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population.CONCLUSIONSDeveloping successful diabetes interventions for minority groups requires a number of stages, careful planning, assessment of cultural characteristics of the target population, and a systematic approach to implementation. [ABSTRACT FROM PUBLISHER]

PURPOSEThe purpose of this study was to identify and describe the scope of practice trends of diabetes educators in the state of Georgia.METHODSThe Diabetes Educator Responsibilities Questionnaire (DERQ) was sent to 221 members of the American Association of Diabetes Educators listed in the 1995 membership directory in Georgia. Of the 221 members, 97 returned completed questionnaires. This population of healthcare professionals comprised the sample population.RESULTSIn assessing the primary responsibilities of the sample, more than 50% of the respondents performed six of the nine educator roles. Less than 50% of the respondents indicated that they "Always" or "Frequently" used behavior modification strategies in teaching people with diabetes.CONCLUSIONSThe questionnaire used in this study should be expanded to elicit more detailed information regarding decisions to use or not use behavior modification techniques in diabetes education. [ABSTRACT FROM PUBLISHER]

The purpose of this study is twofold. First, it provides a review of the literature supporting the development of a new service to help patients with diabetes and their providers manage their care. This service, automated voice messaging (A VM) with nurse follow-up, allows for systematic and intensive patient monitoring and diabetes education as well as a means of focusing clinical resources where they are most needed. Second, it provides a description of a prototype AVM-based diabetes management service that has been developed as part of two ongoing, randomized, controlled trials to test the efficacy of AVM care for patients with Type 2 diabetes. Preliminary findings from implementing this service in two large public healthcare systems suggest that AVM-supported care is feasible, desirable by clinicians and patients with diabetes, and may identify serious health problems that otherwise would go unnoted through standard means of clinic-based patient care. [ABSTRACT FROM PUBLISHER]

A diabetes education program was evaluated using an outcomes management system. Data concerning health status outcomes, including glycemic control (HbA1c), diabetes-related quality of life, and general health-related quality of life, were collected over a 15-month period. This information was collected for each clinic patient at entry into the program and again at a 6-month follow-up session. Patients improved significantly in all categories of outcomes. Newly diagnosed patients showed significantly greater reduction in HbA1c than did patients with a history of diabetes. Health-related quality of life, as measured by symptoms and the SF-36, improved independent of glycemic control. Despite the difficulties of interpreting results from this one-group, pretest-posttest design, the study demonstrated the value of a multidimensional approach to outcome assessment and program evaluation. [ABSTRACT FROM PUBLISHER]

Research on diabetes patient education over the last decade has flourished in a general climate of interest in the therapeutic value of tight metabolic control. That climate is changing. Whether patient education contributes to metabolic control may not be as much a research question in the future as what specific teaching protocols and/or communication strategies produce the highest levels of cognitive and behavioral outcomes. Quality control is a growing area of interest. This paper discusses how each of the symposium presenter's remarks might contribute to research on new teaching methods to increase the overall quality of diabetes patient education. [ABSTRACT FROM PUBLISHER]

Diabetes patient education involves the cognitive, psychomotor, and affective domains. This paper focuses on the influence diabetes patient education has on how people feel about having diabetes and what it means to them. Our research suggests that diabetes patient education can contribute to more positive attitudes about diabetes and that diabetes educators should address the affective domain directly. Strategies for influencing the personal meaning of diabetes are presented and discussed. [ABSTRACT FROM PUBLISHER]

Patient educators need an approach to patient education that balances the constraints of time and expertise with the most effective approaches to behavior change. The stepped approach to patient education involves three steps: (1) use of interpersonal skills, (2) teaching, and (3) overcoming obstacles to behavior change. This paper provides techniques and examples of how to implement the stepped approach to diabetes care. [ABSTRACT FROM PUBLISHER]

Professionals responsible for the care of persons with diabetes mellitus are ever more convinced that patients need a strong, pragmatic knowledge about the disease to survive and thrive. Considerable expertise is being directed toward defining exactly what should be taught and how achievement should be measured and rewarded. This paper briefly reviews the accomplishments computers have made to this end, and describes a new soft ware program using dBASE III Plus that is derived from the author's previous clinical experience. [ABSTRACT FROM PUBLISHER]

A foreword to "Diabetes Educator" is presented.

The article discusses a study on the chronic care model for Latinos with diabetes. Topics discussed include changes in glycosylated hemoglobin, and data on glycemic control. The article concludes that self-management activities implemented by low-income patients, may improve diabetes as reducing the levels of HbA1c.