The Effectiveness of a Self-Efficacy-Focused Structured Education Program (SSEP) in Improving Metabolic Control and Psychological Outcomes of Type 2 Diabetes Patients: A 12-Month Follow-Up of a Multicenter Randomized Controlled Trial
Received 4 November 2020
Accepted for publication 10 December 2020
Published 22 January 2021 Volume 2021:14 Pages 305—313
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Konstantinos Tziomalos
Xin-Jun Jiang,1– 5 Hua Jiang,2 Yuan Chen,6 Xiao-An Wu,7 Xue-Lian Yu,8 Lei Liu,9 Ming-Zi Li2
1Department of Adults Nursing, School of International Nursing, Hainan Medical University, Haikou, People’s Republic of China; 2Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China; 3Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, People’s Republic of China; 4Key Laboratory of Trauma of Hainan Medical University, Hainan Medical University, Haikou, People’s Republic of China; 5Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, The First Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China; 6Department of Endocrinology, Wuyishan Municipal Hospital, Wuyishan, People’s Republic of China; 7Department of Endocrinology, People’s Hospital of Leping City, Leping, People’s Republic of China; 8Department of Endocrinology, Yanhua Hospital, Beijing, People’s Republic of China; 9Department of Health Education, Jimenli Primary Hospital, Beijing, People’s Republic of China
Correspondence: Ming-Zi Li
Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China
Background and Objective: The 12-month follow-up effect of the self-efficacy-focused structured education program (SSEP) requires in-depth confirmation. This study aims to verify whether the benefits of SSEP can be maintained in 12 months.
Materials and Methods: A multicenter randomized controlled trial with 12-month follow-up conducted among 265 type 2 diabetes patients not on insulin from 4 hospitals in mainland China. The intervention group (n = 133) was administrated with SSEP, and the control group (n = 132) received the routine education. The indicators of metabolic and psychosocial aspects of the patients were assessed at baseline and 12 months.
Results: As opposed to the control group, the primary outcomes of HbA1c in the intervention group were improved obviously in the 12th month during the 12-month follow-up (− 1.13%, P < 0.001). The secondary outcomes (ie, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes self-efficacy, diabetes self-management behaviors, diabetes knowledge and diabetes distress) were improved significantly in the intervention group as compared with the control group in the 12th month during the 12-month follow-up (− 3.14 cm, P = 0.001; − 0.30 mmol/L, P = 0.032; − 0.25 mmol/L, P = 0.008; 0.87, P < 0.001; 10.67, P < 0.001; 3.42, P < 0.001; − 4.97, P < 0.001). The non-significant difference in the secondary outcomes (ie, systolic pressure, diastolic pressure, triglycerides and high-density lipoprotein cholesterol) was identified between the two groups in the 12th month during the 12-month follow-up (P > 0.05).
Conclusion: The SSEP provided sustainable benefits in outcomes of HbA1c, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes knowledge, diabetes distress, diabetes self-efficacy and diabetes self-management behaviors for type 2 diabetes patients not on insulin in the 12th month during the 12-month follow-up. Thus, it will be an effective education model capable of being generalized nationwide, and it can be referenced for the nations and regions under consistent conditions.
Clinical Trial Registry: Chinese Clinical Trial Registry (ChiCTR‐IOR‐17011007).
Keywords: diabetes mellitus, type 2, self efficacy, education
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