Strategies to facilitate lifestyle change associated with diabetes mellitus.
OBJECTIVE
To critically examine the literature about strategies and factors that influence lifestyle change in people with diabetes mellitus.


METHODS
This integrative literature review included an extensive search of published literature about strategies to facilitate lifestyle change related to diabetes mellitus. Articles reviewed were empirical studies focused on lifestyle change and were published between 1985 and 1999. Meta-analyses and relevant reviews of the literature were also included. Over 90 article were initially identified, 72 met the specified criteria and could be categorized according to a theoretical framework or a broad topic area.


RESULTS
Studies were clustered into the categories of educational, behavioral, cultural, and health beliefs that influence or are barriers to lifestyle change. Studies indicate that positive outcomes are associated with diabetes education programs that focus on self-management, emphasize behavioral strategies, and provide culturally relevant information.


CONCLUSIONS
Theoretically grounded research in diabetes care is imperative for the future. Expansion of research methods, continued methodological rigor of studies, and instrument development would contribute to knowledge development in diabetes care. Research priorities are proposed.
Whittemore
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Yale University School of Nursing, 100 Church Street South, New Haven, CT 06536, USA. rwhittem@go.com
D003920:Diabetes Mellitus / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D012932:Social Facilitation