title: Assessment of a National Diabetes Education Program diabetes management booklet: The GRADE experience.
abstract: OBJECTIVE
  The National Diabetes Education Program created the 4 Steps to Manage Your Diabetes for Life (4 Steps) booklet to help patients with diabetes learn the basics of self-management and care recommendations. The purpose of this study is to explore the impact of 4 Steps on participants' diabetes management knowledge and self-efficacy in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).
  
  
  METHODS
  A sample of 348 adults with type 2 diabetes enrolled in GRADE was included in this analysis. Participants took a pretest, were sent home with 4 Steps, then took a posttest at their next visit. The Wilcoxon signed rank test was used to detect differences in knowledge and self-efficacy between scale scores pre- and posttest.
  
  
  CONCLUSIONS
  Analyses revealed increases in participants' diabetes management knowledge (p < .001) and self-efficacy (p < .001) from pre- to posttest. Participants who reported no formal previous diabetes education showed a statistically significant increase in knowledge scores compared to those with previous diabetes education (p < .05).
  
  
  CONCLUSIONS
  Appropriate, relevant diabetes education materials may improve self-management knowledge and self-efficacy among adults with type 2 diabetes. Providers should feel confident using 4 Steps as a resource for clinical practice.
authors.affiliation: Hager Sharp Inc., Washington, District of Columbia.
authors.forename: Roshni
authors.initials: R
authors.lastname: Devchand
authors.affiliation: Hager Sharp Inc., Washington, District of Columbia.
authors.forename: Christina
authors.initials: C
authors.lastname: Nicols
authors.affiliation: National Diabetes Education Program (NDEP), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Gallivan
authors.affiliation: GRADE Study Group, Endocrinology, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Margaret
authors.initials: M
authors.lastname: Tiktin
authors.affiliation: GRADE Coordinating Center, Biostatistics Center, The George Washington University, Washington, District of Columbia.
authors.forename: Heidi
authors.initials: H
authors.lastname: Krause-Steinrauf
authors.affiliation: GRADE Study Group, Diabetes Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors.forename: Mary
authors.initials: M
authors.lastname: Larkin
authors.affiliation: National Diabetes Education Program (NDEP), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Tuncer
authors.affiliation: GRADE Coordinating Center, Biostatistics Center, The George Washington University, Washington, District of Columbia.
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States
keywords: Diabetes mellitus type 2; adults; advanced practice nurse; care management; chronic illness; communication; nurse practitioner; patient education; pre-post tests; self-efficacy; self-management