A Virtual World Versus Face-to-Face Intervention Format to Promote Diabetes Self-Management Among African American Women: A Pilot Randomized Clinical Trial The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes. A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country The impact of a social network based intervention on self-management behaviours among patients with type 2 diabetes living in socioeconomically deprived neighbourhoods: a mixed methods approach Comparison of a Mindful Eating Intervention to a Diabetes Self-Management Intervention Among Adults With Type 2 Diabetes Translational research for Diabetes Self-Management in Sri Lanka: A randomized controlled trial. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Effectiveness of self-management promotion educational program among diabetic patients based on health belief model Self-care behaviors in patients with type 2 diabetes: Education intervention base on social cognitive theory. Modular ICT-based patient empowerment framework for self-management of diabetes: Design perspectives and validation results A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness Social factors and barriers to self-care adherence in Hispanic men and women with diabetes.
Background Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost . Objective We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention . Methods We recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent , a behavior-change in-person group program for African Americans with diabetes or pre-diabetes . The program is social cognitive theory – guided , evidence -based , and culturally tailored . Participants were r and omized to participate in the program via virtual world ( Second Life ) or face-to-face , both delivered by a single intervention team . Blinded assessors conducted in-person clinical ( HbA1c ) , behavioral , and psychosocial measurements at baseline and 4-month follow-up . Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests ( two-sided and intention-to-treat analyses for all comparisons ) . Results Participants ( N=89 ) were an average of 52 years old ( SD 10 ) , 60 % had ≤high school , 82 % had household incomes < US $ 30,000 , and computer experience was variable . Overall session attendance was similar across the groups ( 6.8/8 sessions , P=.90 ) . Compared to face-to-face , virtual world was slightly superior for total activity , light activity , and inactivity ( P=.05 , P=.07 , and P=.025 , respectively ) . HbA1c reduction was significant within face-to-face ( −0.46 , P=02 ) but not within virtual world ( −0.31 , P=.19 ) , although there were no significant between group differences in HbA1c ( P=.52 ) . In both groups , 14 % fewer patients had post-intervention HbA1c ≥9 % ( virtual world P=.014 ; face-to-face P=.002 ) , with no significant between group difference ( P=.493 ) . Compared to virtual world , face-to-face was marginally superior for reducing depression symptoms ( P=.051 ) . The virtual world intervention costs were US $ 1117 versus US $ 931 for face-to-face . Conclusions It is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds , and outcomes may be comparable to those of face-to-face interventions . Further effectiveness research is warranted . Trial Registration Clinical Trials.gov NCT01340079 ; http:// clinical trials.gov/show/NCT01340079 ( Archived by WebCite at http://www.webcitation.org/6T2aSvmka ) OBJECTIVE To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support ( DSME/S ) . METHODS We r and omized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education . The primary outcome was change in HbA1C over 6 months . RESULTS At 6 months , HbA1C improved within the plate method [ -0.83 % ( -1.29 , -0.33 ) , P<0.001 ] and carbohydrate counting [ -0.63 % ( -1.03 , -0.18 ) , P=0.04 ] groups but not the control group [ P=0.34 ] . Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months ( carbohydrate counting , P=0.36 ; modified plate method , P=0.08 ) . In a pre-specified subgroup analysis of patients with a baseline HbA1C 7 - 10 % , change in HbA1C from baseline improved in the carbohydrate counting [ -0.86 % ( -1.47 , -0.26 ) , P=0.006 ] and plate method groups [ -0.76 % ( -1.33 , -0.19 ) , P=0.01 ] compared to controls . CONCLUSION CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10 % . PRACTICE IMPLICATION S Both carbohydrate counting and the modified plate method improve glycemic control as part of AIMS We evaluated a theoretically-derived family-oriented intervention aim ed to improve self-efficacy , self-management , glycemic control and quality of life in individuals living with Type 2 diabetes in Thail and . METHODS In a single-blinded r and omized controlled trial , 140 volunteer individuals with Type 2 diabetes , recruited from a diabetes clinic in rural Thail and , were r and omly allocated to intervention and control arms . Those in the intervention arm received routine care plus a family-oriented program that included education classes , group discussion s , a home visit , and a telephone follow-up while the control arm only received routine care . Improvement in outcomes over time ( baseline , Week 3 , and Week 13 following intervention ) was evaluated using Generalized Estimating Equations multivariable analyses . RESULTS Except for age , no between-group significant differences were observed in all other baseline characteristics . Diabetes self-efficacy , self-management , and quality of life improved in the intervention arm but no improvement was observed in the controls . In the risk-adjusted multivariable models , compared to the controls , the intervention arm had significantly better self-efficacy , self-management , outcome expectations , and diabetes knowledge ( p<0.001 , in each ) . Participation in the intervention increased the diabetes self-management score by 14.3 points ( β=14.3 , ( 95 % CI 10.7 - 17.9 ) , p<0.001 ) . Self-management was better in leaner patients and in females . No between-group differences were seen in quality of life or glycemic control , however , in the risk-adjusted multivariable models , higher self-management scores were associated with significantly decreased HbA1c levels ( p<0.001 ) and improved patient quality of life ( p<0.05 ) ( irrespective of group membership ) . CONCLUSIONS Our family-oriented program improved patients ' self-efficacy and self-management , which in turn could decrease HbA1c levels Introduction Diabetes self-management education ( DSME ) is a fundamental element of type 2 diabetes care . Although 75 % of adults with diabetes worldwide live in low-income and middle-income countries ( LMICs ) , limited DSME research has been conducted in LMICs . The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala . Methods We conducted a prospect i ve study of a DSME intervention using a quasi-experimental , single-group pretest – posttest design . We enrolled 90 participants in the intervention , which consisted of 6 home visits ( May 2014–July 2016 ) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan population s. Primary outcomes were changes in mean hemoglobin A1c ( HbA1c ) and mean systolic and diastolic blood pressure at baseline and at 12 months . Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion . Results HbA1c decreased significantly from baseline to 12 months ( absolute mean change , −1.5 % ; 95 % confidence interval [ CI ] , −1.9 % to −1.0 % ; P < .001 ) . Systolic blood pressure also improved significantly at 12 months ( −6.2 mm Hg ; 95 % CI , −10.1 to −2.2 mm Hg ; P = .002 ) ; changes in diastolic blood pressure were not significant ( −1.6 mm Hg ; 95 % CI , −3.9 to −0.7 mm Hg ; P = .17 ) . We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion . Conclusion DSME interventions can be successfully delivered in a setting with an underre source d health system , high poverty rate , and unique cultural characteristics like Mayan Guatemala . Our findings point to the need for more DSME research in re source -limited setting s globally Background Type 2 diabetes ( T2D ) is a significant public health problem , with U.S. Pacific Isl and er communities — such as the Marshallese — bearing a disproportionate burden . Using a community-based participatory approach ( CBPR ) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D . Objectives Led by a collaborative community-academic partnership , the Family Model of Diabetes Self-Management Education ( DSME ) aim ed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family . Design To test the Family Model of DSME , a r and omized , controlled , comparative effectiveness trial with 240 primary participants was implemented . Half of the primary participants were r and omly assigned to the St and ard DSME and half were r and omly assigned to the Family Model DSME . Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period . Methods The Family Model DSME was a cultural adaptation of DSME , whereby the intervention focused on engaging family support for the primary participant with T2D . The St and ard DSME was delivered to the primary participant in a community-based group format . Primary participants and participating family members were assessed at baseline and immediate post-intervention , and will also be assessed at 6 and 12 months . Summary The Family Model of DSME aim ed to improve glycemic control in Marshallese with T2D . The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention 's success and sustainability Purpose . The purpose of this study was to assess the feasibility of the  Spanish Diabetes Self-Management Program ( SDSMP )  in the primary care setting of the Basque Health Service and offer initial estimations of the r and omized controlled trial ( RCT ) effects . Methods . Ten health centers ( HCs ) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012 . Recruitment was performed via invitation letters , health professionals , and the local media . Each intervention group consisted of 8–15 people . The ability of each HC in forming up to 2 groups , participants ' compliance with the course , and coordination and data collection issues were evaluated . Glycated haemoglobin ( HbA1c ) was the main outcome variable . Secondary outcomes were cardiovascular risk factors , drugs consumption , medical visits , quality of life , self-efficacy , physical exercise , and diet . Results . Two HCs did not organize a course . A total of 173 patients initiated the program , 2 dropped out without baseline data , and 90 % completed it . No pre-post HbA1c differences existed . Certain improvements were observed in blood pressure control , self-efficacy , physical activity , and some dietary habits . Conclusion . The SDSMP is feasible in our setting . Our experience can be of interest when planning and conducting this program in similar health setting s. The trial is registered with Clinical Trials.gov identifier NCT01642394 Aims : This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients . This 10-month group intervention targeting patients and significant others aim ed to improve self-management by stimulating social support and diminishing social influences that hinder self-management . Methods : This intervention was evaluated in a quasi-experimental study using a mixed methods approach . Of 131 socioeconomically deprived patients with suboptimal glycaemic control , 69 were assigned to the  intervention  group and 62 to the  control group ( st and ard diabetes education ) . 27 qualitative in-depth interviews with the participants and 24 with their group leaders were held to study the subjective impact of the intervention . Further , self-management behaviours ( medication adherence , diet and physical activity ) were assessed at baseline , 10 and 16 months . Data were analysed using framework analyses and a linear mixture model . Results : Qualitative data showed that the intervention group had a better underst and ing of the way self-management influences diabetes . The intervention group showed more complex self-management behaviours , such as planning ahead , seeking adequate food and physical activity alternatives , and consistently taking their diabetes into consideration when making choices . In participants with complete follow-up data , we found a significant increase in physical activity in the intervention group ( 3.78 vs. 4.83 days ) and no changes in medication adherence and diet . Conclusions : This study indicates that an intensive support group and simultaneously involving significant others might improve diabetes self-management behaviours among socioeconomically deprived patients . More studies are needed to justify further implementation of the intervention . This study is registered in the Dutch Trial Register NTR1886 . http://www.trialregister.nl/trialreg/admin/ rct Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues , improving eating regulation and dietary patterns , reducing symptoms of depression and anxiety , and promoting weight loss . Diabetes self-management education ( DSME ) , which addresses knowledge , self-efficacy , and outcome expectations for improving food choices , also may be an effective intervention for diabetes self-care . Yet few studies have compared the impact of mindful eating to a DSME-based treatment approach on patient outcomes . Adults 35 to 65 years old with type 2 diabetes for ≥1 year not requiring insulin therapy were recruited from the community and r and omly assigned to treatment group . The impact of a group-based 3-month mindful eating intervention ( MB-EAT-D ; n = 27 ) to a group-based 3-month DSME “ Smart Choices ” ( SC ) intervention ( n = 25 ) postintervention and at 3-month follow-up was evaluated . Repeated- measures ANOVA with contrast analysis compared change in outcomes across time . There was no significant difference between groups in weight change . Significant improvement in depressive symptoms , outcome expectations , nutrition and eating-related self-efficacy , and cognitive control and disinhibition of control regarding eating behaviors occurred for both groups ( all p < .0125 ) at 3-month follow-up . The SC group had greater increase in nutrition knowledge and self-efficacy than the MB-EAT-D group ( all p < .05 ) at 3-month follow-up . MB-EAT-D had significant increase in mindfulness , whereas the SC group had significant increase in fruit and vegetable consumption at study end ( all p < .0125 ) . Both SC and MB-EAT-D were effective treatments for diabetes self-management . The availability of mindful eating and DSME-based approaches offers patients greater choices in meeting their self-care needs AIMS The study tested the hypothesis that a theory driven Diabetes Self-Management ( DSM ) intervention delivered by trained nurses would result in a clinical ly significant improvement in glycaemic control . METHODS Patients with an HbA1c > 7.5 % ( 58mmol/mol ) and free of diabetes complications were enrolled into a r and omized controlled trial ( n=85 ) . Intervention consisted of four sessions and monthly follow up for 6 months . Biochemical tests , and diet and physical activity assessment  s were done in both groups . Analysis of covariance was used to test the effectiveness of the intervention . RESULTS At 6 months , there was a significant difference ( P=0.001 ) in HbA1c between the groups controlling for baseline values and other variables . Based on the primary outcome , 28 % in the intervention group achieved the target value of 6.5 % HbA1c , compared to 8 % in the " usual care " group ( P<0.001 ; η(2)=0.65 ) . The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up . CONCLUSIONS The DSM intervention has result ed in a clinical ly significant impact on glycaemia , change in diet and physical activity , and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting OBJECTIVE To assess the effectiveness of a culturally sensitive , structured education programme ( CSSEP ) on biomedical , knowledge , attitude and practice measures among Arabs with type two diabetes . RESEARCH DESIGN S AND METHODS A total of 430 patients with type II diabetes mellitus living in Doha , Qatar were enrolled in the study . They were r and omized to either intervention ( n = 215 ) or a control group  ( n = 215 ) . A baseline and one-year interval levels of biomedical variables including HbA1C , lipid profile , urine for microalbuminuria ; in addition to knowledge , attitude and practice ( KAP ) scores were prospect ively measured . The intervention was based on theory of empowerment , health belief models and was culturally sensitive in relation to language ( Arabic ) , food habits and health beliefs . It consisted of four educational sessions for each group of patients ( 10 - 20 patients per session ) , lasting for 3 - 4 h. The first session discussed diabetes pathophysiology and complications ; while the second session discussed healthy life style incorporating the Idaho plate method ; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques . Outcomes were assessed at base line and 12 months after intervention . RESULTS After 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the ( CSSEP ) group ( -0.55 mmol/L , P = 0.012 ) , fasting blood sugar ( -0.92 mmol/L , P = 0.022 ) , body mass index ( 1.70 , P = 0.001 ) and albumin/creatinine ratio ( -3.09 , P < 0.0001 ) but not in the control group . The intervention group also had improvement in Diabetes knowledge ( 5.9 % , P < 0.0001 ) , attitude ( 6.56 % , P < 0.0001 ) , and practice ( 6.52 % , P = 0.0001 ) . CONCLUSION This study demonstrates the effectiveness of culturally sensitive , structured , group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients Introduction : Diabetes is a chronic disease ; it can cause serious complications . Diabetes self-management is essential for prevention of disease complications . This study was conducted to evaluate self-management promotion educational program intervention efficiency among diabetic patients in Iran and health belief model ( HBM ) was applied as a theoretical framework . Material s and Methods : Overall , 120 Type 2 diabetic patients referred to rural health centers in Gachsaran , Iran participated in this study as r and omly divided into intervention and control group . This was a longitudinal r and omized pre- and post-test series control group design panel study to implement a behavior modification based intervention to promotion self-management among diabetic patients . Cross-tabulation and t-test by using SPSS statistical package , version 16 was used for the statistical analysis . Results : Mean age was 55.07 years ( SD = 9.94 , range : 30 - 70 ) . Our result shows significant improvements in average response for susceptibility , severity , benefit and self-management among intervention group . Additionally , after intervention , average response of the barrier to self-management was decreased among intervention group . Conclusion : Our result showed education program based on HBM was improve of self-management and seems implementing these programs can be effective in the and prevention of diabetes complications AIM This study aim ed to determine the effect of education intervention , based on social cognitive theory , on self-care behaviors in patients with type 2 diabetes . METHODS This study was conducted in descriptive and interventional stages . The effective factors and constructs of social cognitive theory were identified in a descriptive study ( n = 320 ) . After that , a quasi-experimental study was conducted to determine the effect of intervention on 120 diabetic patients whom were r and omly assigned to experimental and control groups . The educational intervention was implemented in six 40 -minute sessions for the experimental group . The question naires were completed before , immediately after and three months after the intervention . RESULTS The results of regression showed that emotional adaptation ( P < 0.05 ) , self-efficacy to overcome barriers ( P < 0.05 ) and self-regulation ( P < 0.05 ) could predict self-care . There was no significant difference between the experimental and control groups before the educational intervention , however , after the intervention , there was a significant difference in self-care ( p < 0.001 ) , knowledge ( p < 0.001 ) , outcome expectations ( p < 0.001 ) , outcome value ( p < 0.001 ) , self-efficacy ( p < 0.001 ) , self-efficacy to overcome barriers(P < 0.001 ) p ) , environment ( p < 0.001 ) , observational learning ( P < 0.05 ) , situational perception ( p < 0.001 ) , self-regulation ( p < 0.001 ) and emotional adaptation ( p < 0.001 ) ) in the intervention group . CONCLUSION The results of this study showed that intervention , based on social cognitive model , has a positive effect on diabetes self-care in the patients . Emotional adaptation , self-efficacy to overcome barriers and self-regulation have the biggest impact on diabetes self-care INTRODUCTION It is estimated that more than 382 million people suffer from diabetes across the globe , most of which are between the age of 40 and 59 years .  ICT can play a key role in better management of diabetes and in patient empowerment . Patient empowerment involves patients to a greater extent in their own healthcare process and disease management becomes an integrated part of their daily life . Self-management opens the possibility for patients to contribute to their own healthcare as well as to be more in control of their disease . OBJECTIVES The objective of our study was to explore the impact of an ICT-based  patient empowerment framework in diabetes self-management . METHODS A modular patient empowerment framework that fosters diabetes self-management was design ed and implemented . The framework incorporates expert knowledge in the form of clinical guidelines , and it supports patients in the specification of personalized activities that are based on medical recommendations and personal goals , and in the collection of observations of daily living . The usability and usefulness of the proposed framework were assessed in a pilot study with the participation of 60 patients and 12 health professionals . RESULTS The study revealed that a patient empowerment approach based on  self-management ICT tools  is useful and accepted by both the patients and the physicians . For those patients who were already disciplined in their disease management the piloted solution served as a facilitator for data logging . For the rest , it served as an incentive for better adherence to disease management principles . The ICT tools prompted many patients into becoming more physically active and into making dietary habits ' adjustments . However , this impact proved to be tightly correlated with the sociocultural background of the subjects . The study also demonstrated that even in patient-centric self-management interventions the physicians still have a key role to play . However , the acceptance of such interventions by the healthcare professionals depends not only on the level of impact in their patients ' disease management but also on the level of impact in their workflow . CONCLUSIONS It is evident that a patient empowerment approach based on self-management ICT tools is useful and accepted by patients and physicians . Further , there are clear indications that ICT frameworks such as the one presented in this paper support patients in behavioral changes and in better disease management . Finally , it was realized that self-management solutions should be built around the objective not only to educate and guide patients in disease self-management , but also to assist them in exploring the decision space and to provide insight and explanations about the impact of their own values on the decision Objective In a r and omized trial , a guided diabetes peer support intervention improved glycemic control ( A1c ) , with a difference in A1c change between groups of 0.58 % ( p = 0.004 ) . The current study examined whether improvements in insulin uptake and perceived diabetes social support mediated the intervention ’s impact on A1c . We also examined potential moderation by patients ’ health literacy , diabetes social support , or diabetes distress . Methods We conducted secondary analyses for 212 type 2 diabetes patients participating in the trial using accepted methods for testing mediation and moderation effects . Results : Roughly half ( 49 % , 95 % CI : 3–80 % ) of the A1c effect was mediated by increased insulin use , while changes in diabetes social support had a negligible impact . A1c impacts varied across subgroups defined by baseline diabetes social support and functional health literacy ( both p < 0.01 ) . The intervention was particularly beneficial among patients with low baseline diabetes support or literacy levels . The intervention had a greater impact on A1c among patients with more frequent engagement in peer support calls ( p < 0.01 ) . Discussion Patients receiving increased peer support had improved glycemic control largely due to their greater likelihood of initiating insulin . Greater intervention engagement was associated with stronger effects . The intervention had its greatest benefits among patients with low support or poorer health literacy OBJECTIVE To explore quantitatively the extent to which social support , social norms  and  barriers  are associated with self-efficacy and self-care adherence in Hispanic patients with diabetes and the extent to which these differ for men and women . METHODS Baseline survey data were collected from 248 low-SES , Hispanic men and women who were participants in a r and omized controlled trial of a culturally targeted intervention for diabetes management .  Student 's t , Pearson correlations and multiple regression were used to analyze the data . RESULTS Compared to men , women were less likely to receive support , faced more barriers , reported less self-efficacy and had lower levels of self-care adherence . Perceived support was consistently correlated with better self-efficacy in women but not men , even though men reported higher levels of support . CONCLUSION The lack of adequate support seems to be a fundamental barrier for Hispanic women with diabetes . PRACTICE IMPLICATION S Health care providers should be sensitive to sociocultural influences in Hispanic groups that may facilitate men 's self-care adherence , but could potentially hamper women 's efforts . Interventions design ed for Hispanics should augment women 's support needs and address culture and social factors that may differentially impact the ability of men and women to manage their diabetes
BACKGROUND Permanent compliance of self-care behaviors is a challenging issue in managing chronic diseases like diabetes .
The evidence supports theory-based intervention in promoting self-care behaviors .
However , no systematic review was done to monitor these interventions and compare more effective constructs .
This study was conducted to investigate the studies using self-care theories and introducing the most effective theories .