Diabetes self-management education research - An international review of intervention methods, theories, community partnerships and outcomes

An international literature search was conducted to identify studies published since 1995 examining the effects of diabetes self-management education (DSME) in community settings. Of the 24 publications identified, eight were examined to provide a discussion of intervention methods, the use by study authors of behavioral theories and models to explain cognitive and psychosocial processes, the employment of community partnerships and collaborations to enhance patient and community ownership of DSME, and the effects of DSME on intermediate- and short-term outcomes. Reported intermediate outcomes established that researchers are now beginning to recognize the complexity of diabetes. Interventions across publications included the use of lay health educators, family members in learning sessions, exercise classes in the community, support groups, and cooking demonstrations. Only two of eight studies identified a behavioral theory to explain cognitive and psychosocial processes. The lead agencies in all eight studies were medical universities or diabetes clinics that worked closely with community partners to deliver DSME in community settings. Community partners included diabetes centers, local churches, residential centers, and work sites. Studies in this review examined the effect of DSME on intermediate outcomes that included exercise, self-care behaviors, dietary habits, clinical service usage, self-esteem, social support, diabetes knowledge, and health beliefs, with one or more studies finding improvements in dietary habits, exercise, and diabetes knowledge. Short-term outcomes such as fasting glucose, glycosylated hemoglobin (HbA(1c)), body mass index, weight, blood pressure, total cholesterol, triglycerides, and impaired glucose tolerance were also examined. In at least one study, DSME favorably affected HbA(1c), cholesterol, body mass index, blood pressure, and fasting glucose. Studies discussed in this review demonstrated the effectiveness of a single DMSE intervention delivered in community settings. DSME has proven effective in improving both intermediate- and short-term outcomes. This review also revealed opportunities to improve the effectiveness of DSME studies in community settings. Future DSME studies should give more attention to identifying appropriate behavioral theories or models that help explain the mediating effects of cognitive and psychological processes on diabetes self-management. DSME studies in the future should continue to improve study designs to strengthen the credibility of research findings, use both qualitative and quantitative methods to capture intervention effects; and engage community members and partners in developing, implementing, and evaluating DSME interventions.