title: Lasting impact of an implemented self-management programme for people with type 2 diabetes referred from primary care: a one-group, before-after design.
abstract: BACKGROUND
  Research interventions in uniform clinical settings and in patients fulfilling well-defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self-Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented.
  
  
  OBJECTIVE
  To examine the impact of an established group-based DSME in unselected people with type 2 diabetes referred from primary care.
  
  
  METHODS
  A one-group, before-after design was used for assessments before, immediately after, and 3 months after participation in a group-based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self-efficacy (General Self-Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t-tests for normally distributed data and Wilcoxon signed-rank test for skewed data.
  
  
  RESULTS
  Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3-month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period.
  
  
  CONCLUSIONS
  The complexity self-management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected diabetes patients referred from primary care.
authors.affiliation: Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
authors.forename: Mari
authors.initials: M
authors.lastname: Fløde
authors.affiliation: Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.|Department of Medicine, Section of Endocrinology, Stavanger University, Stavanger, Norway.
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Iversen
authors.affiliation: Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Aarflot
authors.affiliation: Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haltbakk
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011320:Primary Health Care; D012017:Referral and Consultation; D012648:Self Care
keywords: counselling; diabetes; health education; medical nursing; patient participation