An Examination of the Factors that Impact the Implementation and Effectiveness of Diabetes Self-Management Programs

Abstract

Diabetes is a highly prevalent condition in the United States that calls for dedicated public health intervention. The main purpose of this dissertation is to examine the factors that impact the implementation and effectiveness of diabetes self-management programs. Thus, two studies were undertaken: a systematic literature review on process evaluations of diabetes-specific traditional group-based programs and a secondary data analysis using the Behavioral Risk Factor Surveillance System’s (BRFSS) 2018 survey data, which examines the relationship between attending diabetes education and whether or not an individual with diabetes gets their A1C checked by a healthcare professional at least twice a year. As a whole, this dissertation discusses both process and outcome evaluation aspects of diabetes-specific programs. It closes the gap related to the lack of focused attention on how process evaluations can determine whether or not participants achieve expected outcomes of self-management. The first study utilized the PRISMA approach for conducting systematic reviews. Findings revealed that there is a lack of theoretically grounded process evaluations of diabetes-specific traditional group-based programs that incorporate mixed methods of data collection embedding assessments of acceptable program delivery such as fidelity, dose delivered, reach, and dose received. The second study assessed the impact of attending diabetes education on frequency of A1C checks by health care professionals in the past 12 months. Findings revealed BRFSS respondents who resided in states other than Texas displayed a statistically significant relationship between attending diabetes education and an individual with diabetes getting their A1C checked at least twice/year. Also, when assessing the impact of location of residence, residing in an urban environment strengthened the relationship between attending diabetes education and getting one’s A1C checked at least twice/year for those that reside in states outside Texas.