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/mÂ²
- 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