title: Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial.
abstract: To compare the effectiveness of three delivery modalities of Decision-making Education for Choices In Diabetes Everyday (DECIDE), a nine-module, literacy-adapted diabetes and cardiovascular disease (CVD) education and problem-solving training, compared with an enhanced usual care (UC), on clinical and behavioral outcomes among urban African Americans with type 2 diabetes.
  
  
  
  Eligible participants (n = 182) had a suboptimal CVD risk factor profile (A1C, blood pressure, and/or lipids). Participants were randomized to DECIDE Self-Study (n = 46), DECIDE Individual (n = 45), DECIDE Group (n = 46), or Enhanced UC (n = 45). Intervention duration was 18-20 weeks. Outcomes were A1C, blood pressure, lipids, problem-solving, disease knowledge, and self-care activities, all measured at baseline, 1 week, and 6 months after completion of the intervention.
  
  
  
  DECIDE modalities and Enhanced UC did not significantly differ in clinical outcomes at 6 months postintervention. In participants with A1C ≥7.5% (58 mmol/mol) at baseline, A1C declined in each DECIDE modality at 1 week postintervention (P < 0.05) and only in Self-Study at 6 months postintervention (b = -0.24, P < 0.05). There was significant reduction in systolic blood pressure in Self-Study (b = -4.04) and Group (b = -3.59) at 6 months postintervention. Self-Study, Individual, and Enhanced UC had significant declines in LDL and Self-Study had an increase in HDL (b = 1.76, P < 0.05) at 6 months postintervention. Self-Study and Individual had a higher increase in knowledge than Enhanced UC (P < 0.05), and all arms improved in problem-solving (P < 0.01) at 6 months postintervention.
  
  
  
  DECIDE modalities showed benefits after intervention. Self-Study demonstrated robust improvements across clinical and behavioral outcomes, suggesting program suitability for broader dissemination to populations with similar educational and literacy levels.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.|The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Fitzpatrick
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.|The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kerry
authors.initials: K
authors.lastname: Stewart
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: June
authors.initials: J
authors.lastname: Sutherland
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Sharie
authors.initials: S
authors.lastname: DeGross
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Tina
authors.initials: T
authors.lastname: Brown
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.|The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.|Johns Hopkins School of Nursing, Baltimore, MD.
authors.forename: Jerilyn
authors.initials: J
authors.lastname: Allen
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.|The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.|Johns Hopkins School of Nursing, Baltimore, MD.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD fbriggs3@jhmi.edu.|The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.|Johns Hopkins School of Nursing, Baltimore, MD.
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy; D002755:Choice Behavior; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D012307:Risk Factors; D012648:Self Care; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D006442:Glycated Hemoglobin