Small steps, large problems: advances in the management of diabetes mellitus

The efficacy of theory driven treatment adherence promotion program among type 2 diabetic patients: application of intervention mapping and mHealth

Background

Mobile health interventions (mHealth) may improve health-related lifestyle behaviors and disease management. Successful management of diabetes is patient-centered responsibility. The aim of this research was to determine the efficacy of the theory driven program of promoting treatment adherence in type 2 diabetes (T2DM) patients based on mHealth.

Methods

This quasi-experimental research was conducted on 70 T2DM patients in Tehran, Iran. Participants were randomly divided into intervention (n = 35) or control (n = 35) groups. The data collection tool was a questionnaire based on some of constructs Social Cognitive Theory (SCT) which elicit from formative evaluation. The SCT theory-based intervention program was developed, implemented, and evaluated based on Intervention Mapping (IM) as a framework in 8 sessions using online WhatsApp application. The data was collected through by online interviews before and one month after the implementation of the program and analyzed in SPSS version 16.

Results

After the implementation of the program, a significant increase in self-efficacy (P = 0.009), outcome expectations (P < 0.001), and also diabetes treatment adherence behaviors (P = 0.024) were indicated in the intervention group. The estimated effect sizes for self-efficacy, outcome expectations, social support, and diabetes treatment adherence behaviors were 0.78, 0.06, 0.07, and 0.62, respectively.

Conclusion

Estimated effect size of the implemented intervention was evaluated as "large" effect for diabetes treatment adherence behaviors. Findings indicated the usefulness and efficacy of the mHealth educational program based on SCT constructs and the IM approach in treatment adherence behaviors promotion among T2DM patients in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01291-5.

Improvement in Knowledge, Social Cognitive Theory Variables, and Movement through Stages of Change after a Community-Based Diabetes Education Program

The objective of this program was to demonstrate the impact of a community-based diabetes education program. Participants were adults (N=239; mean age+/-standard deviation=63+/-10 years) with diabetes or caretakers. Community-based education incorporating Social Cognitive Theory and Stages of Change Theory included three group sessions focused on meal planning with cooking demonstrations. Knowledge and Social Cognitive Theory/Stages of Change variables were assessed pre- and postintervention. At posttest, significantly more (P<.05) used herbs in place of salt, cooked with olive or canola oils, used artificial sweeteners in baking (Stages of Change Theory), and were confident to change their diet and to prepare healthful meals. Knowledge of diabetes and nutrition increased (P<.05) and was a factor in postintervention belief in ability to use food labels and that meal planning was helpful. This community-based diabetes education intervention resulted in positive impacts on knowledge, health beliefs, and self-reported behaviors. Improvement in knowledge can be instrumental in moving individuals to an action or maintenance stage and in improving self-efficacy.