title: What does theory-driven evaluation add to the analysis of self-reported outcomes of diabetes education? A comparative realist evaluation of a participatory patient education approach.
abstract: To explore the effects of the Next Education (NEED) patient education approach in diabetes education.
  
  
  
  We tested the use of the NEED approach at eight intervention sites (n=193). Six additional sites served as controls (n=58). Data were collected through questionnaires, interviews and observations. We analysed data using descriptive statistics, logistic regression and systematic text condensation.
  
  
  
  Results from logistic regression demonstrated better overall assessment of education program experiences and enhanced self-reported improvements in maintaining medications correctly among patients from intervention sites, as compared to control sites. Interviews and observations suggested that improvements in health behavior could be explained by mechanisms related to the education setting, including using person-centeredness and dialogue. However, similar mechanisms were observed at control sites. Observations suggested that the quality of group dynamics, patients' motivation and educators' ability to facilitate participation in education, supported by the NEED approach, contributed to better results at intervention sites.
  
  
  
  The use of participatory approaches and, in particular, the NEED patient education approach in group-based diabetes education improved self-management skills and health behavior outcomes among individuals with diabetes.
  
  
  
  The use of dialogue tools in diabetes education is advised for educators.
authors.affiliation: Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark. Electronic address: riap@steno.dk.
authors.forename: Regitze A S
authors.initials: RA
authors.lastname: Pals
authors.affiliation: Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark. Electronic address: koee@steno.dk.
authors.forename: Kasper
authors.initials: K
authors.lastname: Olesen
authors.affiliation: Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark. Electronic address: iwtp@steno.dk.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Willaing
mesh_terms: D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D010353:Patient Education as Topic; D036301:Qualitative Research; D012648:Self Care; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: Diabetes; Dialogue tools; Participatory methods; Patient education; Realist evaluation