title: Persian Diabetes Self-Management Education (PDSME) program: evaluation of effectiveness in Iran.
abstract: Despite increasing rate of diabetes, no standard self-management education protocol has been developed in Iran. We designed Persian Diabetes Self-Management Education (PDSME) program using intervention mapping. Effectiveness of program was assessed in newly diagnosed people with type 2 diabetes and those who had received little self-management education. Individuals aged 18 and older (n = 350) were recruited in this prospective controlled trial during 2009-2011 in Tehran, Iran. Patients were excluded if they were pregnant, were housebound or had reduced cognitive ability. Participants were randomly allocated in intervention and control groups. PDSME patients attended eight workshops over 4-week period following two follow-up sessions. Validated questionnaires assessed cognitive outcomes at baseline, 2 and 8 weeks. HbA1c was assessed before and 18-21 months after intervention in both groups. The CONSORT statement was adhered to where possible. A total of 280 individuals (80%) attended the program. By 18-21 months, the PDSME group showed significant improvements in mean HbA1c (-1.1 versus +0.2%, p =0.008, repeated measure ANOVA (RMA)). Diabetes knowledge improved more in PDSME patients treated with oral antidiabetic agents than in those receiving usual care over time (RMA, F = 67.08, p < 0.001). Statistically significant improvements were seen in PDSME patients for self-care behaviors, health beliefs, attitudes toward diabetes, stigma, self-efficacy and patient satisfaction. PDSME program was effective in improving self-management cognitive and clinical outcomes. Results support use of intervention mapping for planning effective interventions. Given the large number of people with diabetes and lack of affordable diabetes education, PDSME deserves consideration for implementation.
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Shakibazadeh
authors.affiliation: Division of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, School of Public Health, University of Texas, Health Science Center at Houston, Houston, TX, USA.
authors.forename: Leona Kay
authors.initials: LK
authors.lastname: Bartholomew
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran arashidian@tums.ac.ir.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Endocrine and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Bagher
authors.initials: B
authors.lastname: Larijani
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Iran; health planning; program evaluation; type 2 diabetes