Academic journal article Research and Theory for Nursing Practice

Intervention Mapping Protocol for Developing a Theory-Based Diabetes Self-Management Education Program

Academic journal article Research and Theory for Nursing Practice

Intervention Mapping Protocol for Developing a Theory-Based Diabetes Self-Management Education Program

Article excerpt

Development of behavior theory-based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome-focused health education programs.

Keywords: intervention mapping; information-motivation-behavioral skills (IMB) model; behavior change; self-management

About 20%-25% of the population aged older than 65 years in the United States (Kirkman et al., 2012) and Korea (Korean Diabetes Association [KDA], 2012) has diabetes. Glycemic control is an important strategy in preventing complications for people with diabetes. Only 50.6% of people with diabetes have an optimum level of glycemic control, based on the hemoglobin A1c (A1c) level of less than 7.0% in Korea (KDA, 2012). One study examining a large cohort of people with diabetes aged 60 years and older (Huang, Liu, Moffet, John, & Karter, 2011) showed higher mortality with an A1c greater than 8%; this pattern was the same as that shown in younger subjects. Current American Diabetes Association (ADA) guidelines for older adults with diabetes suggest that it will be helpful to consider the heterogeneity of persons aged 65 years and older (Kirkman et al., 2012). These guidelines recommend that glycemic goals for older adults should be varied according to their function, cognition, and life expectancy and so may have higher A1c recommendations (Kirkman et al., 2012). It is still recommended, however, to have a target A1c level of less than 7% in functional older adults with more than 10-15 years of life expectancy (Kirkman et al., 2012). Controlling blood pressure is another important factor in preventing complications for older adults with diabetes, and the benefit of lower blood pressure in this study was consistent through later years (Kirkman et al., 2012). There is clear evidence of benefit from controlling the levels of cholesterol in younger adults with diabetes; evidence is not sufficient for older adults, but lower cholesterol levels are still recommended even with lower levels of evidence (Kirkman et al., 2012).

Improving self-management behavior in people with diabetes is an important strategy to include on top of a medical regimen to achieve glucose, blood pressure, and cholesterol goals. Diabetes self-management education (DSME) must be tailored to meet the needs of each individual with diabetes (Kirkman et al., 2012). Special consideration is needed for better DSME outcomes such as decreased hearing, vision, and cognitive and functional levels when designing self-management education for older adults (Kirkman et al., 2012).

Older people with diabetes who exist in a community, especially those who visit senior centers, have high functionality and relatively long life expectancy among the older population. …

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