Table 2 —

Effect of self-management training on knowledge, attitudes, and self-care skills

Referencen, F/U interval, and mean ageInterventionsOutcomesComments
1. Didactic, knowledge, and information interventions
33n = 60; F/U immediate, 4 weeks; ?ageI: Four weekly group sessions; individual as needed C: Started same education 4 weeks laterIncreased knowledge I vs. C at 4 weeks, P < 0.01No BL statistics; I more visits than C Attrition 29%, dropouts not equal to completers at BL Low participation rate, but NSD participants and nonparticipants
34n = 345; F/U immediate; 58 yearsI: Nine multimedia education classes over 1.5 years C: Usual careIncreased knowledge I vs. C, P = 0.0073 NSD behavior score; NSD foot lesionsNo mention blinding assessor Low participation rate; nonparticipants older, more males
35n = 77; F/U 6–18 months from BL; 33 yearsI: 5-day IP teaching: didactic, individual F/U q3 months, phone access; instruction in self-adjustment insulin C: 5-day IP “traditional” education + written information; 3 × 1.5-h sessions; q3 months F/UIncreased knowledge both C and I, I > C, P < 0.01 at 12 months Increased urine testing I and C (NSD between groups) Knowledge not correlated with BS controlNo BL comparison statistics No attrition information No blinding for diet history Low recruitment rate and no information on nonparticipants
42n = 30; F/U immediate; 59 yearsI: 15-min video featuring local HCW in SpanishIncreased knowledge in I, effect size moderate (0.61)No BL comparison of demographics Unclear if assessor blinded
C: Pretest only, then viewed videoConvenience sample
I had no pretest to avoid bias from retesting
47n = 51; F/U 12 months from BL; 53 yearsI: Three weekly didactic, small group sessions q4 months + q2 months visit with doctorNSD knowledge between groupsI more visits than C No information on participation rates
C: Visit with doctor q2 months
51n = 40; F/U immediate; 60 yearsI: 1-h individual education based on patient’s priorities C: 1 h individual education based on educator’s prioritiesIncreased knowledge both groups, P < 0.0001, NSD between groupsUnclear if assessor blinded Consecutively referred patients Type of DM unclear
52n = 111; F/U 2–3 months; 56 yearsI: One-page drug information sheet given to patients attending clinicBoth groups increased knowledge; NSD between groups
C: Usual care
57n = 31; F/U 1 week; HbA1c F/U 2 months; 65 yearsI: Four weekly TC after hospital discharge: identify deficits and teachI more frequent SMBG and increased hypoglycemic prevention, P < 0.05I more contact than C Unclear if assessor blinded No information on nonparticipants
C: No TC or other contact
2. Collaborative, knowledge, and information interventions
26n = 80; F/U 6 months from BL; 53 yearsI: Group sessions: didactic and discussions; no details of duration or frequency; F/U every 3 monthsIncreased knowledge in I vs. C, P < 0.01Attrition 25%, no comparison dropouts to completers
C: Care at general medical clinic every 3 months
27,28n = 532; F/U 12–14 months; 57 yearsI: Average 2.4 sessions × 1.5 h over 2 months + home visit, TC F/U, contracting, skill exercises, goal-setting; over 26 months C: Usual careAchievement of some knowledge, skill, and self-care objectives in I vs. C, P < 0.05I more visits than C Attrition 51%, differences dropouts and completers No blinding assessor Low participation rate
29n = 238; F/U 3, 6, 12 months from BL; 56 yearsI-1: 13 individual sessions in 12 monthsIncreased knowledge I-3 at 3 and 6 months, P < 0.05BL differences: I-2 better educated, I-1 longer duration DM
I-2: Three-day interactive course + F/U 3 and 9 months + two individual sessions I-3: Six or more individual sessions based on cognitive behavior theory, TC F/U over 12 monthsI more visits than C Dropouts longer duration DM than completers Unclear if study population represents target population
C: 2 × 1-hour group education
30n = 46; F/U immediate, 6 months; 66 years1: 8 × 2-hour small group sessions over 3 months; problem- and participant-focused C: One-day didactic teachingIncreased knowledge at 6 months I vs. C, P < 0.05I more visits than C More C excluded due to poor control No mention blinding assessor Nonparticipants older and heavier
32n = 174; F/U 4–6 months; 57 yearsI-1: Computer knowledge assessment program (KAP) + interactive computer teaching (60 min) I-2: KAP (20–40 min) + feedback I-3: KAP onlyIncreased knowledge all I, P < 0.05 (within group)Randomization by year and birth month (no details given) I more contact than C NIDDM results reported here (49% of total study population IDDM)
C: No intervention
40,60n = 558; F/U 6 months; 45 yearsI-1: Collaborative education by HCW, 3 h/week × 4 weeks I-2: Same education, led by fellow patient C: No intervention I based on Fishbein and Ajzen Health Belief ModelIncreased knowledge both I, P < 0.001; Increased DM locus of control, P < 0.001 Improved attitude and frequency SMBG both I, P < 0.05 Increased self-adjustment of insulin both I, P < 0.01Hospitals randomized I more visits than C Uncertain blinding assessor
44n = 24; F/U immediate; 35–65 yearsI: 1-h computer-based drill with feedback including explanation of correct answerIncreased knowledge in I vs. C, P = 0.005 NSD attitudes toward the drillNo BL comparisons Volunteer study population
C: As for I, but right/wrong feedback only
I and C received 14-min instructive video before computer drill
46n = 471; F/U 6, 12 months from BL; 52 yearsI: Home visits, teaching based on needs assessment, maximum 12 visits C: Usual careIncreased knowledge at 6 months, P = 0.001 NSD foot appearance score at 6 monthsAttrition 20%, no comparison dropouts to completers 70% of eligible participated
Increased medication skills at 6 months, P = 0.04 and urine testing, P = 0.01
48n = 82; F/U 6 months from BL; 56 yearsI-1: 11 × 2-h didactic weekly course + 1 individual sessionIncreased knowledge for all three groups; NSD between groupsNo BL statistics comparing groups I more visits than C
I-2: 11-week course + three individual sessions: barriers and support C: Usual careNSD health locus of controlAttrition 40%, no comparison dropouts to completers Volunteer study population
50n = 40; F/U 3 months; 57 yearsI: CAI, 4 × 1-h sessions: didactic, some feedback and testing C: Didactic group teaching; 4 × 3-hIncreased knowledge both groups; NSD between groupsNo BL group comparison statistics Low participation rate, no information on nonparticipants or dropouts
54n = 107; F/U 1, 4 months; 60 yearsI: 2 × 2-h group didactic + practice + feedback + usual care C: Usual care: individual education based on perceived patient need Both in IP settingIncreased compliance to insulin injection time for I at 4 months, P = 0.05Randomized by hospital number No blinding assessor No information on participation rates
55n = 41; F/U 2 months; 60 yearsI-1: Three-day program + group session with pharmacistNSD change in knowledge between I and C or between I-1 and I-2No BL comparison I more contact than C
I-2: Three-day program + individual session with pharmacist; TC F/U C: Standard center 3-day education programImproved attitudes/perceptions towards medications in I vs. C, P < 0.05 NSD attitudes to SMBG23% had unusable data for SMBG
56n = 53; F/U 3–5 weeks; 63 yearsI: 2 × 5-min TC in 5 weeks; focus knowledge and skillsNSD overall knowledgeAttrition 25%, no comparison dropouts to completers
C: 2 × 15-min individual visits in 5 weeks, same content
Both groups individual education immediately before intervention
59n = 60; F/U 3 months from BL; 55 yearsI: Three-day group education, with F/U of four TC and one home visit; reinforce knowledge and skillsFrequency SMBG I > C, P < 0.0001I more contact than C Unclear if study population represents target population
C: Three-day group education
98n = 22; F/U 32 weeks from BL; 61 yearsI: Weekly to biweekly home visits: nutrition, exercise, foot care, SMBG; by nursing students C: Usual careNSD knowledge between groups Increased self-care competency in I vs. C, P = 0.003Attrition 24%, no comparison dropouts to completers No mention blinding assessor Unclear if study population represents target population
99n = 56; F/U 6 months; 64 yearsI: Monthly × 6 group sessions: behavior modification (contracts, feedback), and general knowledge C: Usual careIncreased knowledge at 6 months, P = 0.0003I more contact than C Attrition 32%, no comparison dropouts to completers Participation rate 37%, no comparison participants to nonparticipants
108n = 280; F/U 6 months; 55 yearsI: Education on importance of eye examination: booklet, video; one interactive TC C: Usual careIncreased rate of retinal examination in I (OR = 4.3, 95% CI 2.4–7.8)
3. Lifestyle interventions
31n = 40; F/U 6 months from BL; 35 yearsI-1: Lunch demonstrations I-2: Videotape education C: Dietitian instruction and written information Three visits total for all groups over 6 monthsIncreased knowledge in I-1 and I-2, P < 0.001No mention blinding assessor Study population selected by researchers; low participation rate Type of diabetes unclear (“insulin dependent”)
36n = 87; F/U 12 months from BL; 56 yearsI: Five group sessions over 6 months, focus on weight lossIncreased knowledge I > C, P < 0.001
C: Individual education on weight loss by dietitian; 3 or more visits in 12 months
37n = 105; F/U 6 months; 58 yearsI: Diet guide: guidelines, nutrition goals, food logs C: Traditional exchange list teaching Both groups taught at 3 × 2.25-h weekly sessionsNSD diet principals; Increased applied nutrition knowledge I > C, P < 0.01 Attitude to life and diet, and diet knowledge improved I and C, P < 0.05Attrition 21%, no information on dropouts Unclear how patients recruited
38n = 32; F/U immediate; 53 yearsI: Two sessions: dietitian and CAI C: 2 × 30-min sessions: dietitian only Teaching for both over ∼1 monthIncreased exchange list knowledge for I, P < 0.05; NSD CNo BL statistics Unclear if blinding assessor Type of DM unclear
39n = 105; F/U immediate, 12 months; 45 yearsI: Interactive computer program on diet; 90 min/month over 6 months C: Wait listed for I Both groups received 5 days of teachingIncreased knowledge for I, P < 0.0001; NSD for CI more contact than C Attrition appears to be 76% at 12 months F/U No comparison dropouts to completers No mention blinding assessor No information on patient  recruitment Crossover design
43n = 201; F/U 6 months; 53 yearsI: Culturally appropriate flashcards: diet, SMBG; delivered by lay HCWIncreased knowledge, self-care in I vs. C, P < 0.05I more contact than C Intensity of intervention unclear
C: Usual care
49n = 41; F/U 6 months; 61 yearsI: Psychologist-led group sessions on PA and diet C: Didactic lectures on diet and DM Both groups 10 × 1-h sessions over 6 monthsIncreased knowledge for both groups, P < 0.05, NSD between groupsDropouts (22%) had higher mean BS; equal number dropouts I and C Low participation rate, no information on nonparticipants
75n = 66; F/U 4 months; 30–86 yearsI: 5 × 90-min weekly sessions by nurse: diet, PA, barriers, social and group support C: No information on care receivedImproved health attitudes I vs. C, P = 0.015 NSD perceptions of health relating to DMNo BL statistics Volunteer study population Number of visits uncertain
76n = 64; F/U 3, 6 months from BL; 62 yearsI: 12 × 1.5-h weekly (didactic) sessions, then 6 × 1.5-h biweekly participatory sessions; based on social action theoryIncreased nutrition knowledge at 3 months; NSD from BL at 6 monthsI more visits than C More C dropouts, no comparison dropouts to completers Volunteer study population
C: One didactic class and two mailings
80n = 40; F/U 2, 5 months from BL; 59 yearsI: 3 × 1.5-h individual learning activity packages with diet information, goals, activities C: 3 × 1.5-h didactic lecturesIncreased knowledge for 1 at 5 months, P < 0.05Attrition 23%, no comparison dropouts to completers Volunteer study population from DM education program
83n = 596; F/U immediate, 6 months; 51 yearsI: More nutrition content, follow food pyramid C: Usual education, given meal plan Both I and C: 5 × 2-h weekly group sessionsNSD attrition, knowledge, self-care between choice/no choice groups NSD knowledge, self-care between I and CRandomized into choice/no choice of program, then I and C Attrition 28%, dropouts younger, more male No mention blinding assessor Physician-referred patients or volunteers
95n = 120; 12 months from BL; 61 yearsI: Group education (diet, PA, BS control) q3 months × 4 C: Usual careIncreased knowledge in I, P < 0.001I more contact than C Unclear if study population represents target population
4. Skills teaching interventions
41n = 70; F/U 6 months; 59 yearsI: 9 h over 4 weeks: participatory foot care based on cognitive motivation theory C: Usual DM teaching: 14 h didactic/3 days, including 1 h foot careIncreased knowledge both groups at 6 months, I > C, P < 0.001 Increased compliance foot care routines at 6 months, I > C, P = 0.012 Compliance correlates with decreased foot problems, P = 0.002 Decreased food problems both I and C, NSD between groups at 6 months Compliance correlates with decreased foot problems, P = 0.002Volunteer study population
45n = 34; F/U 8 weeks; 37 yearsI: Self-study course on self-control and self-management SMBG, over 4 weeks C: Usual careIncreased knowledge and skills for I > C, P < 0.01 Increased SMBG goal adherance rate more for I than C, P < 0.01No BL statistics Attrition 26%, no comparison dropouts to completers Community recruitment; participants self-selected Type of DM unclear
53n = 50; F/U 1 month; 73 yearsI: 24-min instructional video on technique SMBGIncreased knowledge both groups, NSD between groupsNo mention blinding assessor
C: Group didactic instruction on technique SMBGNo improvement SMBG technique I or C
58n = 30; F/U immediate; 55 yearsI: SMBG instruction for 30 min by educator C: Self-instruction SMBG for 30 minDecreased error BS measurement in I, P < 0.01
62n = 395; F/U 12 months from BL; 60 yearsI: Group foot education with F/U ×3 over 3 months; chart reminders for providers, provider guidelines C: Usual careDecreased serious foot lesions in I at 1 year, P = 0.05 I had more appropriate foot care behaviors, P < 0.05 Physicians examined I feet more often at office visits, P < 0.001Randomized by practice team I more contact than C Low participation rate; no information on nonparticipants
63n = 50; F/U 6 months; adultI: Additional participatory teaching on foot careSelf-care practices increased both groups, no statisticsRandomized by week entering program; no BL comparisons
C: Usual education, with routine, didactic foot education Both groups: 5 days of OP DM educationIncreased knowledge foot care for C only, P = 0.02 NSD physical assessment feet I or CAttrition 35% I, 44% C, no comparison dropouts to completers No mention blinding assessor No demographic data; type of DM unclear
64n = 203; F/U 13 months I, 9 months C; ?ageI: 1-h didactic group education on foot care C: No educationDecreased foot ulcer rate, P < 0.005 Decreased amputation rate, P < 0.025 NSD infection rateRandomized on SSN No information on dropouts No mention blinding assessor No information on nonparticipants Type of DM unclear
5. Coping skills interventions
85n = 64; F/U 6 weeks; 50 yearsI: 6 × 2-h weekly group sessions: patient empowerment, goal-setting, problem solving, stress management C: Wait listedIncreased 4/8 self-efficacy subscales, between group difference, P < 0.02No BL comparisons; 18 patients not randomly assigned I more contact than C Volunteer study population 64% DM2 HbA1c measured immediately after program for C, 6 weeks after for I
86n = 32; F/U 2 years; 68 yearsI-1: Six weekly sessions + 18 monthly support group sessions: coping, discussion, educationIncreased knowledge maintained for I-1 at 2 years, P < 0.05C is nonrandomized comparison group More visits for I-1 > I-2 > C
I-2: Six-week sessions only; wait list for support group C: Usual careNo information on attrition Unclear if study population represents target population
Type of DM unclear
  • BL, baseline; BS, blood sugar; BP, blood pressure; C, C-1, C-2, control groups; CAI, computer-assisted instruction; CHO, carbohydrate; D/SBP, diastolic/systolic blood pressure; DM, diabetes mellitus; DM2, type 2 diabetes; FBS, fasting blood sugar; F/U, follow-up; HCW, health-care worker; I, I-1, I-2, I-3, intervention groups; IP, inpatient; NSD, no significant difference; OP, outpatient; PA, physical activity; q, every; RN, registered nurse; SD, significant difference; TC, telephone call.