A Diabetes Self-Management Education Program Based on the Information-Motivation-Behavioral Skills Model: Effects on Older Adults with Type 2 Diabetes in Korea

Sunday, 27 July 2014

Suyoung Choi, PhD, GNP, RN1
Misoon Song, RN, PhD2
Se-an Kim, RN, MSN2
Kyoungsan Seo, RN, MSN2
Soo Jin Lee, RN, MSN2
(1)College of Nursing Jeju National University, Jeju-si, South Korea
(2)College of Nursing, Seoul National University, Seoul, South Korea

Purpose: The purpose of this study was to evaluate the effect of the Diabetes Self-Management Education for Older Koreans (DSME-OK) program based on the Information-Motivation-Behavioral skills (IMB) model. The unique characteristics of the DSME-OK program are the application of the IMB model and utilization of the intervention mapping (IM) protocol. The IMB model includes three important behavioral change resources: information, motivation, and behavioral skills. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation.

Methods: A two-group, quasi-experimental study design was used to test the DSME-OK program with community-dwelling older adults in Korea. The DSME-OK program has 14 weekly 90-minute sessions. It has adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. Thirty older adults between 66 and 90 years old (mean 76.8 ± 5.4) completed the entire research protocol and assessments at four time points. Changes in scores (from baseline to 14 weeks and 3- and 6-month follow-up) of outcome variables were compared between the intervention group (n = 15) and the control group (n = 15).

Results: At 14 weeks, diabetes self-management motivation (p = 0.042) was higher in the DSME-OK program participants than usual care control subjects. At 3- and 6-month follow ups, diabetes self-management motivation (p = 0.022), self-efficacy (p = 0.004), and self-management knowledge (p = 0.039) were higher in the DSME-OK program participants than the controls. However, the groups did not significantly differ in A1C, lipids (triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), and self-management behavior change scores. These variables were relatively similar between groups at baseline.

Conclusion: This theory-based self-management program that focused on behavioral outcomes was effective for improving diabetes self-management information, motivation, and behavioral skills for older adults with diabetes. These results provide further evidence of the effectiveness of theory-based interventions for changing self-management behaviors. Further studies should attempt to replicate the current findings by using larger samples and longer time frames.