Objective: To compare diabetes Treatment as Usual (TAU) with a Pathways to Change (PTC) intervention to determine whether the intervention would result in improved readiness for self-monitoring of blood glucose (SMBG), healthy eating and/or smoking cessation (Jones and others, 2003).

Research Design and Methods

  • n=1,029 (Type 1 or type 2 diabetes).
  • n=860 for SMBG
  • n=445 in a pre-action stage for healthy eating (diet >30% fat) with a BMI >27kg/m²
  • n=168 in pre-action for smoking
  • A randomized split-plot design with treatment (TAU vs. PTC) and strips (free strips and no strips) as two randomized between-subject factors, and pre- vs. post-study as the within-subject factor.
  • Monthly mail or telephone contact for one year.
  • After recruitment, PTC participants were mailed a handbook with general diabetes information and an intro to the TTM.
  • A personalized feedback report for each self-care behavior was generated from a computer-based "expert system" based on survey responses.
  • Counselors called participants one month after the personal report to answer questions, provide behavior change tips, and help with goal setting.
  • Seven newsletters were mailed every other month.
  • Regular doctor visits and/or diabetes education sessions.
  • Participants were required to visit the diabetes center twice, and use a memory blood glucose meter and phone modem to send results to a data center.


  • SMBG participants moving to an action stage:
    • 43.4% receiving PTC plus strips
    • 30.5 receiving PTC alone
    • 27% receiving TAU plus strips
    • 18.4% receiving TAU alone
  • Healthy eating intervention participants moving to action or maintenance
    • 32.5% receiving PTC
    • 25.8% receiving TAU
  • Smoking intervention participants moving to an action stage
    • 24.3% receiving PTC
    • 13.4% receiving TAU
  • Conclusions: The PTC intervention was a success and significantly better than TAU at fostering behavior change