title: Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project. The Effect of Educational Program Based on BASNEF Model for Eye Care in Non-insulin Dependent Diabetic Patients. Culturally Competent Diabetes Education for Mexican Americans: The Starr County Study Improving glycaemic control self-efficacy and glycaemic control behaviour in Chinese patients with type 2 diabetes mellitus: randomised controlled trial. The effectiveness of nutritional education on the knowledge of diabetic patients using the health belief model Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Effect of a diabetes counseling programme on knowledge, attitude and practice among diabetic patients in Erode district of South India The Effect of Health Belief Model Educational Program and Jogging on Control of Sugar in Type 2 Diabetic Patients Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial Peer-Led Diabetes Education Programs in High-Risk Mexican Americans Improve Glycemic Control Compared With Standard Approaches The effects of education based on extended health belief model in type 2 diabetic patients: a randomized controlled trial The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Development of an illustrated medication schedule as a low-literacy patient education tool. Group Education and Nurse-Telephone Follow-Up Effects on Blood Glucose Control and Adherence to Treatment in Type 2 Diabetes Patients Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Effect of a Bicultural Community Health Worker on Completion of Diabetes Education in a Hispanic Population
abstract: Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels BACKGROUND The purpose of this study was to determine the effects of educational program based on the BASNEF ( Belief , Attitude , Subjective Norm , and Enabling Factors ) Model on eye care among patients with insulin independent diabetes mellitus in Shiraz City , Fars Province , Iran . METHODS We enrolled 100 patients with non-insulin independent diabetes mellitus ( Type II ) fulfilling the inclusion criteria of this experimental study . The participants were r and omly divided into two groups , one experimental , and one control group . All groups completed the question naires based on the BASNEF Model , a checklist related to patient 's practice including patients ' HbA1c and FBS levels , the pre-test results of an ophthalmologist 's eyes examination and the results of three months follow-up . The experimental group participated in eight educational sessions during the interventional . The data analysis used including chi square-test , t-test , and ANOVA . RESULTS The knowledge and all BASNEF Model components were significantly increased in the experimental group compared to the control group after intervention . In addition , behavioral eye care , such as physical activities , regular taking medicine , having eye examination , FBS checking , having appropriate diet , HbA1c level , and fasting blood sugar levels improved significantly among the experimental group compared to the control group . CONCLUSION Applying the BASNEF Model is very effective for developing an educational program for diabetic patients , in order to control their blood sugar and enhancing behavioral eye care . Besides such programs , follow up education on controlling and monitoring is highly recommended PURPOSE Few culturally competent health programs have been design ed for Mexican Americans , a group that bears a disproportionate burden of Type 2 diabetes . In Starr County , a Texas-Mexico border community , investigators design ed and tested a culturally competent intervention aim ed at improving the health of this target population . The purpose of this article is to describe the development process of this diabetes education and support group intervention . METHODS The development stages were ( 1 ) community assessment , ( 2 ) intervention design , ( 3 ) selection or development of outcomes , ( 4 ) pilot testing , and ( 5 ) a r and omized clinical investigation . RESULTS Focus group participants identified knowledge deficits regarding diabetes and self-management strategies , and suggested characteristics of an effective intervention for Mexican Americans . Outcome measures included metabolic control indicators , a newly developed knowledge instrument , and an existing health belief instrument . Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population . CONCLUSIONS Developing successful diabetes interventions for minority groups requires a number of stages , careful planning , assessment of cultural characteristics of the target population , and a systematic approach to implementation AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention BACKGROUND : Patients have a major role in the control and treatment of type 2 diabetes . So , knowledge of different aspects of this disease especially diet therapy is very important for these patients . This study was conducted to determine the effectiveness of the Health Belief Model ( HBM ) on nutrition education in type 2 diabetic patients . METHOD : Eighty eight type 2 diabetic patients attending Iranian Diabetes Association seminars were r and omly selected to participate in the study ( 44 in intervention group and 44 in control group ) . The intervention was consisted of two educational sessions each one for 80 minutes . Data were collected by a vali date d and reliable question naire ( 58 questions ) before intervention and one month after intervention . RESULTS : After intervention , knowledge scores increased in the intervention group compared to the control group ( Mean differences in the intervention and test group : 22.68 ± 15.90 vs - 2.27 ± 17.30 , P < 0.001 ) . Perceived susceptibility increased significantly in the intervention group compared to the control group ( 27.5 ± 18.5 vs 3.9 ± 17.2 , P < 0.001 ) . The result was the same for perceived severity , perceived threatened and perceived benefits ( P < 0.001 ) . In contrast perceived barriers reduced in the intervention group compared to the control diet ( -14.7 ± 13.3 vs 0.9 ± 13.9 , P < 0.001 ) . In the intervention group , behavior grade s increased more than control group ( 34.61 ± 14.93 vs -0.23 ± 8.52 , P < 0.001 ) . CONCLUSION : The efficacy of the health belief model in nutritional education to the diabetic patients was confirmed in the present study BACKGROUND : This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center ( IEMRC ) from April 2008 to January 2009 . METHODS : In a r and omized controlled clinical trial , a total of 172 patients with uncontrolled type 2 diabetes were selected and r and omly allocated into control and intervention groups . After taking informed written consent , the intervention group received an educational program about oral anti-hyperglycemic medications , adherence , diabetes dairy log and pill box usage . Patient 's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist .  Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups . RESULTS : After a three months follow-up , mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group ( p < 0.001 ) . CONCLUSIONS : This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics . The results suggest the benefits of adding adherence education to the diabetic education programs AIMS To explore the impact of pictorial image and teach back educational strategies on knowledge , adherence to medication and diet among patients with type 2 diabetes and low health literacy in Saqqez , Iran . METHODS In this r and omized controlled trial , 127 patients with type 2 diabetes who had low health literacy were r and omly allocated into three arms of the study ( pictorial image , teach back , and control groups ) . The two intervention groups received education within three weekly sessions , each lasting 20 min . The level of functional health literacy in adults ( TOFHLA ) , diabetes knowledge , and adherence to medication and diet were measured and compared in the three groups before and six weeks after the interventions . We used intention to treat analysis . Data were analyzed using ANOVA and Paired t test . RESULTS Mean scores of knowledge , adherence to medication and diet revealed significant differences between two intervention groups and control group ( P<0/001 ) six weeks after intervention . CONCLUSIONS Both educational strategies increased knowledge , as well as adherence to medications and diet among patients with type 2 diabetes and low health literacy . Both educational strategies seem to be effective for patients with low health literacy and are recommended to be used according to patients ' conditions The prevalence of diabetes in India has grown over the past decade . Diabetic patients develop complications due to poor awareness regarding the disease and inadequate glycemic control . Patient education is the most effective way to lessen the complications of diabetes and its management . A total of 207 ( 85 males and 122 females ) type 2 diabetes mellitus patients were enrolled and r and omized into test and control groups . Patients in the test group received counseling at each visit and information leaflets from the pharmacist ; the control group patients received counseling and information leaflets only at the end of the study . A vali date d knowledge , attitude , and practice ( KAP ) question naire was administered to both test and control group patients at baseline and at final follow-up to assess awareness regarding disease management . Glucose and lipid levels were also evaluated at baseline and final follow-up in both the groups . At the end of the study , the KAP score of test group patients improved significantly ( P<0.0001 ) , whereas no significant changes were observed in control group patients . The postpr and ial blood glucose ( PPBG ) levels decreased significantly in the test group . Total cholesterol ( TC ) , triglycerides ( TGL ) , and low density lipoprotein levels ( LDL ) also showed a decrease in the test group . Thus , our study reveals that pharmacist counseling might be an important element in diabetes management programs Background Research ers believe that most of diabetic patients are not necessarily aware of the role of exercises , especially jogging in controlling their disease . The purpose of this study was to evaluate the effect of educational program and jogging based on health belief model ( HBM ) on sugar control in type 2 diabetic patients . Methods One hundred diabetic ( type 2 ) patients were involved in this prospect i ve quasi-experimental interventional study . Patients were r and omly divided into two groups of experimental and control . Data was collected using a question naire based on the HBM model , a check list for patient`s practice s and a check list for recording the patient`s hemoglobin ( HbA1C ) and fasting blood sugar ( FBS ) levels . Results Our findings indicated that after intervention , there was a significant difference between the mean score of the HBM model variables ( susceptibility , severity , benefit and perceived obstacles , ) in the experimental group compared to the control group . Additionally , behavioral jogging , level of HbA1C and FBS levels improved significantly among the experimental group when compared to the control group . Conclusion Applying the HBM model was found to be a very effective means for developing an educational program of jogging for diabetics , in order to control their blood sugar Background Diabetes has become a major public health problem in China . Support of patient self-management is a key component of effective diabetes care and improved patient outcomes . A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999 . However , the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai . This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors , self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai . Methods 208 patients with type 2 diabetes aged 35–80 years were r and omly assigned to the intervention group ( n=119 ) of 12 monthly group visit sessions or to a control group ( n=89 ) of usual care . The trial was undertaken in two rural communities in Shanghai , China . R and omization and allocation to study group were carried out by using a r and om number table . Analysis of covariance was used to compare changes in the 17 self-management behavior , self-efficacy and health status related variables in two groups at 12 months ’ follow-up based on 176 patients ( n=98 ; n=78 ) . Results Compared with controls , the intervention patients , on average , increased their duration of aerobic exercise  by more than 40 minutes per week ( p=0.001 ) ; had significant increase of 0.71 in mean score on self-efficacy to manage diabetes ( p=0.02 ) ; and had significant improvements in measures of illness intrusiveness and systolic blood pressure . The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6 % of them attended 10 and more sessions . Conclusion The Chinese diabetes group visit model is a feasible , acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities . The model requires larger studies to determine its effect on blood glucose control and health care utilization . Trial registration IS RCT OBJECTIVE To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost , peer-educator format ( Project Dulce ) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c > 8 % were r and omly assigned to the  Project Dulce peer intervention or continuation of st and ard diabetes care . The primary outcome of interest was HbA1c . RESULTS The majority of subjects were born in Mexico , were female , were middle-aged , had less than an eighth- grade education , and had high baseline HbA1c levels . Significant time-by-group interaction effects for HbA1c ( P = 0.02 ) and diastolic blood pressure ( P = 0.04 ) indicated that the Project Dulce group exhibited greater improvement ( i.e. , decreases ) across time . Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c ( −1.7 % , P = 0.001 ) and HDL cholesterol ( + 1.4 mg/dL , P = 0.01 ) and from baseline to month 10 in absolute levels of HbA1c ( −1.5 % , P = 0.01 ) , total cholesterol ( −7.2 mg/dL , P = 0.04 ) , HDL cholesterol ( + 1.6 mg/dL , P = 0.01 ) , and LDL cholesterol ( −8.1 mg/dL , P = 0.02 ) . No significant changes were noted in the control group . CONCLUSIONS This r and omized trial , using the Project Dulce model of culturally sensitive , peer-led education , demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic population s is effective Background Type II diabetes and its complications impose a large economic burden on health care systems . This study aims to assess the effectiveness of educational intervention based on extended health belief model on type 2 diabetic patients . Methods 120 patients with type II diabetes referring to r and omly selected hospitals of Tehran University of Medical Sciences were enrolled in this educational intervention study . Patients were r and omly divided into two groups ( intervention and control ) . Data were collected using a question naire including demographic information and extended health belief model constructs . Two face to face educational sessions were conducted for each patient . Data were collected in two groups at three stages of the study ; before the educational sessions and at 3 months and 6 months intervals . Analysis was performed by SPSS ( 17.0 ) and STATA ( 11.0 ) using independent T-test , Chi-square , Fisher ’s exact test , analysis of covariance and Generalized Estimating Equation . A p value of less than 0.05 was regarded as statistically significant . Results The educational program had a positive and significant impact ( p < 0.0001 ) on extended health model belief constructs ( including perceived susceptibility , perceived intensity , perceived benefits , perceived barriers and self-efficacy ) in experimental group , 3 and 6 months after the intervention . Conclusions The results of this study showed the importance of extended health belief model based education in improving the model constructs and increasing self-efficacy in patients with type-2 diabetes OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE Patients with low health literacy have difficulty underst and ing prescription drug labels and other medication instructions . This article describes the development , implementation , and preliminary evaluation of an illustrated medication schedule ( a " pill card " ) that depicts a patient 's daily medication regimen using pill images and icons . METHODS Participants in a r and omized controlled trial who were assigned to receive the pill card intervention  described their use of the card and its perceived effectiveness . Responses were analyzed by level of patient literacy and other characteristics . RESULTS Among the 209 respondents , 173 ( 83 % ) reported using the pill card when they initially received it , though use declined to 60 % approximately 3 months later . Patients with inadequate or marginal literacy skills , less than high school education , or cognitive impairment were most likely to refer to the card on a regular basis initially and at 3 months ( p<0.05 ) . Most pill card users ( 92 % ) rated the tool as very easy to underst and , and 94 % found it helpful for remembering important medication information , such as the name , purpose , or time of administration . CONCLUSION Nearly all patients considered an illustrated medication schedule to be a useful and easily understood tool to assist with medication management . Patients with limited literacy skills , educational attainment , or cognitive function referred to the aid with greater frequency . PRACTICE IMPLICATION S Picture-based instructions promote better underst and ing of prescription medications , particularly among patients with limited literacy skills or cognitive impairment , and should be used more widely in practice Background : Training and continuous dynamic communication between patients and health professionals in chronic diseases like diabetes , is important . The aim of this study is to evaluate the effects of diabetes self-care group education and nurse- telephone follow-up on glycemic control and compliance with treatment orders in patients with type 2 diabetes attending to diabetes clinic in khomein . Methods : In this clinical trial , 62 patients with type 2 diabetes who attending to the diabetes clinic selected and were r and omly assigned to experiment and control groups . Self-care group education was applied for case group ( n = 31 ) and they were followed up using telephone calls for 12 weeks by a nurse . The control group ( n = 31 ) received the conventional management .  Demographic characteristics , compliance with treatment recommendations ( diet , drug use , exercise ) and blood glucose control indices were recorded before and after interventions . Data were analyzed by SPSS software version 16 using independent t-test , paired t-test , Chi-square test , non-parametric tests , mixed model ( ANOVA + repeated measure ) and ANCOVA . Results : The mean age of intervention and control groups was 50.9 ± 7.3 and 55.1 ± 10.1 years , respectively . Blood glucose indices ( FBS , 2 hpp BS , Hb A1C ) were improved in both case and control group after intervention but it was only statistically significant in case group P > 0.0001 . During study , percentage of patients with very good compliance in control group decrease from 12.5 % to zero ( 0 % ) , whereas in experiment group these amounts increase from 6.5 % to 90.3 % P > 0.0001 . Conclusions : According to the results of the current study self-care group education and 12 weeks follow-up by a nurse using telephone causes significant improvement in metabolic parameters and adherence to treatment recommendations in diabetic patients AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs OBJECTIVE To determine the effect of a bicultural community health worker ( CHW ) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge , self-care behaviors , and glycemic control . RESEARCH DESIGN AND METHODS Patients were r and omized into CHW intervention and non-CHW intervention groups . All patients received individualized , comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information , diabetes knowledge , diabetes self-care practice s , and glycohemoglobin levels were assessed . Rates of education program completion were determined . Diabetes knowledge , self-care practice s , and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline . Logistic regression analysis and the Mantel-Haenszel χ2 statistic were used to determine the effect of the CHW assignment on program completion . Analyses of covariance were performed with end-of-treatment behavior scores , knowledge scores , and glycohemoglobin levels as outcome variables , controlling for baseline values and testing for the effect of CHW assignment . RESULTS Of 64 patients enrolled in the study , 40 ( 63 % ) completed and 24 ( 37 % ) dropped out before completing the diabetes education program . Of the patients having CHW intervention , 80 % completed the education program , compared with 47 % of patients without CHW intervention ( P = 0.01 ) . “ Dropouts ” were younger ( age 47.5 ± 12.5 years [ mean ± SD ] ) compared with patients who completed the program ( 55.9 ± 9.9 years ) ( P = 0.004 ) . Dropout status showed no significant relationship to educational level achieved or literacy level . For the program “ completers , ” knowledge levels and selected self-care practice s significantly improved , and glycohemoglobin levels improved from a baseline level of 11.7 % to 9.9 % at program completion ( P = 0.004 ) and 9.5 % at the postprogram follow-up ( P < 0.001 ) . The effect of the CHW assignment on program completion , controlling for financial status and language spoken , was extremely robust ( P = 0.007 ) . The effect of the CHW on knowledge , self-care behavior , or glycohemoglobin outcome variables was not statistically significant . CONCLUSIONS These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained . Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge , self-care behaviors , and glycemic control
target: Interventions were generally effective on behavior change and patients ’ glycemic control in the short term ( ≤9 months ) .
  Conclusions The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population
background: Purpose Although self-management education is a key factor in the care for diabetes patients , its implementation in developing countries is not well documented .
  This systematic review considers the published literature on diabetes self-management education in high and low mortality developing countries .
  The aim is to provide a state of the art of current practice s and assess program outcomes , cultural sensitivity , and accessibility to low literate patients .