Learning Objective #1: Describe the use of the Health Belief Model in addressing self-management strategies for patients with diabetes

Learning Objective #2: Discuss the lessons learned from intervention research using three approaches to improving self-management in diabetes

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The objective of this study was to compare the effectiveness of client-centered strategies for self-management among the South Carolina population of patients with diabetes. The study paid particular attention to patients with diabetes who resided in rural South Carolina where lack of access is frequently cited as a reason for lack of self-management. HbA1c was used as the primary outcome measure. The Health Belief Model was used to guide the intervention and selection of outcome measures.

Two hundred-fifteen patients at two rural sites comprised the sample. They were divided into three groups: the first group (111) participated in monthly visits that provided educational content about diabetes self-management and also was designed to serve as a support group; a second group (42) received a book on self-management of diabetes; the third group (62) received usual care as was standard for other patients in each of the practice sites.

HbA1c levels, weight and blood pressure were measured three times during the project: at initiation, 6 months, and completion at 12 months. Self-efficacy and diabetes knowledge were measured at initiation and completion of the study. Although there were no significant differences between the groups on any of the variables of interest (HbA1c levels, self-efficacy, diabetes knowledge, weight, and blood pressure) some interesting lessons emerged from this study. The importance of group support and a buddy system were sited by participants as an important factor in long-term compliance. The Health Belief Model will be used as the framework for the discussion.