Table 2—

Features of interventions

Author(s)Target of the interventionNeeds assessmentTailoring to the population describedComponents of the interventionDiabetes-related contentTiming/intensityProvider of intervention
Fanning et al. (2004) (20)Health systemNone identifiedNot describedIntervention groups received one-on-one individualized medical care from nurse case managers following specific treatment hyperglycemia algorithms.Participants in the intervention group were assessed at each visit using treatment hyperglycemia algorithms. This included review of their blood glucose logs, weight management, self-monitoring of blood glucose, exercise, and education class attendance.During the 12-month follow-up visit, participants in groups 1, 2, and 3 had 11, 10, and 9 follow-up visits, respectively.Nurse case managers.
Rothman et al. (2004) (21)Patient and health systemNone identifiedIndividualized communication including verbal education with concrete, simplified explanations of critical behaviors and goals; “teach-back” to assess comprehension; and picture-based materials.The intervention consisted of three components: 1) one-on-one educational counseling and medication management sessions; 2) evidence-based treatment algorithms for initiation and titration of blood pressure–and glucose-lowering medications; and 3) strategies to address patient barriers, including transportation difficulties and lack of health insurance.Main topics addressed in the sessions included treatment goals, identification of hypoglycemic and hyperglycemic symptoms, prevention of long-term complications, and self-care.Participants were contacted by telephone or in person every 2–4 weeks and followed for 12 months.Three clinical pharmacist practitioners and a diabetes care coordinator.
The California Medi-Cal Type 2 Diabetes Study Group (2004) (22)Patient and health systemNone identifiedIndividualized treatment and education strategies designed to address barriers to care. Education strategies considered education, literacy and functional understanding, treatment goals, general health status, cultural beliefs, and support network.The intervention group received collaborative case management including evidence-based guidelines for glucose, hypertension, dyslipidemia, and medication management; glucose meter and education; general diabetes and self-management education by diabetes educators; and ongoing contact to support ongoing retention. Participants received one-on-one individualized assessment and education.The case management interventions consisted of blood glucose management; nutrition education and management; exercise, foot care, retinopathy, neuropathy, hypertension, dyslipidemia, and cardiovascular disease assessment management; and regular monitoring of participant progress.Intensity not specified. Mean duration of follow-up was 25.3 months.Registered nurses and registered dietitians working in close collaboration with an endocrinologist.
Davidson (2003) (23)Health systemNone identifiedNot describedParticipants in the intervention group received one-on-one individualized diabetes care from nurses or pharmacists who followed detailed protocols and algorithms under the supervision of a diabetologist.The protocols and algorithms addressed evaluation and management of glycemic control, lipids, neuropathy, and microalbuminuria.Intensity not specified. The time period of the study was 2 years.Clinic A had a full-time nurse, a part-time nurse, and a part-time pharmacist. Clinic B had one full-time nurse.
Echeverry et al. (2003) (24)ProviderNone identifiedReminder cards were developed at the fifth-grade level, and the message was written in English and also in Spanish.Participants in the intervention sites were given reminder cards to show to their provider at their next regular medical visit to prompt performance of three process measures of diabetes care. The nonintervention group did not receive reminders (usual care).The reminder card included prompts of three process-of-care measures for diabetes: foot exams, urine protein, and lipid panel.Intensity not specified. Length of follow-up was 1 month.Physician
Gary et al. (2003) (25)Patient and health systemNone identifiedNot describedIntervention groups received usual care plus 1) NCM intervention with care coordinated according to clinical practice guidelines, 2) CHW intervention, and 3) NCM + CHW (combined team) intervention.Participants in the NCM group received coordinated care according to the ADA clinical practice guidelines. The CHW scheduled appointments, monitored behaviors, mobilized social support, reinforced treatment recommendations, provided education, and provided physician feedback.NCM and CHW visits were 45–60 min long. A total of 25% of the NCM and 62% of the CHW group had at least three visits over 2 years. Half of participants received at least one telephone intervention.Nurse case manager and community health workers.
Miller et al. (2003) (26)Health systemNone identifiedNot describedDuring each visit, participants had an A1C measured using a rapid-testing instrument (DCA 2000). Patients were randomized into a “rapid” group, and A1C results were revealed to the provider at the time of the visit, or a “routine” group, and results were revealed to the provider after the patient visit.A rapid A1C test provided results at the time of the participant visit to assist in treatment decisions.Study visits included a baseline and two follow-up visits scheduled 2–4 months apart.Clinic was staffed by three family practitioners, two general internists, and three nurse practitioners.
Chapin, Williams, and Adair (2003) (27)PatientInput for design of the intervention obtained through meetings with nurses, resident and staff physicians, social workers, diabetes educators, and a health psychologist.The development of the intervention tool focused on using visual communication to emphasized achievable patient-specific actions and how these connect with clinical results. Colors (e.g. red, green) were used to indicate agree of acceptability of readings.The THDR was designed as a patient-physician communication tool. The tool was used during the medical visit to discuss diabetes management and monitoring and was provided to participants after the visit to take home where family could help with the self-care activities.The THDR included medication taking, home glucose tests, frequency of exercise, frequency of eye exam, and blood glucose and A1C readings.The form was updated at each visit. Intensity was not specified. Length of follow-up was 15 months.Physician
Clancy et al. (2003) (28)PatientNone identifiedThis specific intervention was developed to deliver health information efficiently to patients by a multidisciplinary team, to provide socialization opportunities, and as an alternative to brief one-on-one physician visits.During the group visit, participants received didactic group education, individualized assessment of needs, and one-on-one consultations with the health care providers if patients needed care in between scheduled visits or if specific medical needs could not be accommodated in the group visit.The educational components discussed during the group visit included a health-related topic such as nutrition, exercise, sick day management, and stress management.Two-hour group visits monthly for 6 months.Group visits were co-led by an internal medicine physician and a diabetes nurse educator.
Brown et al. (2002) (29)PatientFormal needs assessment including focus groups with providers, community, and patients; materials designed and adapted for language and culture; effectiveness measures validated; and intervention pilot tested. (37)The intervention employed bilingual health care providers from the community, used videotapes with community leaders, and focused on recommendations consistent with population preferences. The intervention was designed to be community based, promote problem solving, provide feedback, and obtain family support and involvement.The intervention included weekly education group sessions and biweekly support group sessions in local schools, churches, county agricultural extension offices, adult day care centers, and health clinics. Education sessions, predominantly in Spanish, used videotapes and hands on experience (e.g. visits to local grocery store). Social support was fostered through family members and friends, group participants, the intervention team, and community workers.The education session included nutrition, self-monitoring of blood glucose, exercise, and other self-care topics. The goals of the support group sessions were to promote behavior changes through informal discussion, problem solving, and preparation demonstrations and provided opportunities to discuss problems with managing diabetes.Twelve 2-h education sessions weekly for 3 months. Support group sessions included 6 months of biweekly and 3 months of monthly 3-h support sessions.Bilingual Mexican-American nurses, dieticians, and community workers.
Keyserling et al. (2002) (30)PatientNeeds assessment using 11 focus groups with African-American women to explore diet, physical activity, psychosocial issues, and role of community diabetes advisor. Additional six focus groups for pretesting (38).The intervention was based on behavior change theory and included individualized tailoring of lifestyle change advice. Educational materials were developed at the fifth- or sixth-grade level, used illustrations, and behavior change recommendations were broken into small achievable steps. A community component was designed to improve cultural relevance as well as to provide social support, feedback, and reinforcement.Group A received clinic and community intervention including individual counseling visits and two group sessions and monthly phone calls from a peer educator. The community component included a physical activity assessment that facilitated individual tailoring of lifestyle change. Group B received individual counseling visits. Group C were mailed pamphlets published by the ADA.The community component consisted of 1) a physical activity education component developed to increase moderate-intensity physical activity to a cumulative total of 30 min per day, 2) a dietary education component designed to decrease total and saturated fat intake and to improve control and distribution of carbohydrate intake, and 3) a diabetes care education component addressing various aspects of diabetes self-care.During the first 6 months, groups A and B received individual counseling visits at months 1, 2, 3, and 4. Group A received two group sessions and monthly phone calls from a peer educator. During the second 6-month period, group A continued to receive monthly phone calls.Clinic-based counseling by a nutritionist. Community facilitation by diabetes advisors and peer counselors who were African-American women with type 2 diabetes.
Davidson et al. (2000) (31)Health systemNone identifiedNot describedDiabetes care in the experimental group was delivered by pharmacists who followed a detailed algorithm written by a diabetologist.The algorithms addressed evaluation and management of glycemic and lipid control.A total of 15.5 visits in the experimental group over a 12-month period and 8.8 visits among control subjects.Pharmacists
Basch et al. (1999) (32)PatientNone identifiedNot describedThe intervention included a low-literacy, nine-page color booklet; a motivational videotape; and one-on-one semistructured telephone education and counseling. The booklet and videotape were mailed to participants. If during follow-up telephone calls it was determined necessary, participants received individually tailored mailings of tip sheets provided practical strategies for overcoming barriers.The booklet addressed diabetic retinopathy, what you can do about diabetic retinopathy, and encouraged yearly dilated eye examination. The videotape used emotional appeals to increase motivation for the yearly eye exam.The median number of phone calls was four, and the median time spent per person was 53 min.Health educator
Agurs-Collins et al. (1997) (33)PatientNone identifiedThe intervention was designed for older African-American adults including the use of large-print, easy-to-read materials; a focus on a limited number of concepts at each session; and the use of materials depicting African-American individuals, families, and community settings. Guidance about food and recipes was based on the types of foods and flavorings characteristic in African-American communities.Intervention participants received group education sessions (8–10 participants) providing nutrition education and exercise; an individualized weight reduction diet; individualized evaluation and exercise prescription; and food and exercise diaries for self-monitoring. Verbal and written feedback was provided for the food and exercise diaries.Nutrition education included meal planning, food shopping, label reading, recipe modification, food selection in restaurants, and creative cooking. The exercise component consisted of a 5-min warm-up, 20 min of low impact aerobic activity, and a 5-min cool down. The behavioral component included strategies such as goal setting, controlling or avoiding triggers to eat, and portion control.A total of 12 weekly sessions of 1 h of education followed by 0.5 h of exercise for the first 6 months followed by 6 biweekly group sessions in the second 6 months.Registered dietitian and exercise physiologist, both African American.
Elshaw et al. (1994) (34)PatientNone identifiedVideos were developed in English and Spanish using the format of a television drama and were designed to be culturally sensitive and appropriate to populations with poorly developed abstraction skills and with low literacy rates.The intervention group received education weekly sessions in groups of 8–10 participants in a local community setting. Sessions were delivered didactically with a videotape and incorporated group discussions.Education session topics were hypertension, nutrition, foot care, eye care, oral health, and kidney as they related to self-care and diabetes complications.Participants received weekly 2-h education sessions for 8 weeks. Follow-up sessions were conducted at 10 and 14 weeks.Two Mexican-American bilingual nurses
Heath et al. (1987) (35)PatientNone identifiedNot describedCommunity-based program offering group aerobic exercise sessions (15–50 participants/session).One-hour aerobic exercise session.One-hour sessions were offered several times a day, five times per week. The mean duration of program attendance was 37 weeks, with a mean of 1.7 sessions per week (range 1–102).A health educator, 2 health education assistants, and 48 Zuni Indians trained in exercise and group leadership.
Mulrow et al. (1987) (36)PatientNone identifiedMaterials used in the intervention were written at a fourth- to sixth-grade educational level.Group 1 received group sessions (three to five participants) using a standardized videotape lesson, printed materials, and personalized goal setting. Group 2 received monthly group sessions (three to five participants) with didactic education and open discussion. Group 3 received a single didactic lecture.Group 1 included three sessions focusing on dietary habits, two covering basic concepts of diabetes, complications, and urine testing and one addressing a physical exercise program. Group 2 included a first session covering concepts of diabetes, diet, and urine testing and subsequent sessions that had open discussion for weight and blood glucose feedback monitoring.Group 1 had a 0.5-h session monthly for 6 months. Group 2 had a 1-h initial session then monthly 0.5-h sessions.Nurse clinician, trained in diabetes education
  • ADA, American Diabetes Association; CHW, community health worker; NCM, nurse case manager; THDR, Take-Home Diabetes Record.