Effectiveness of A Theory-based Intervention to Promote Diabetes
Management Behaviours Among Adults with Type 2 Diabetes in Iran: A
Randomized Control Trial
Abstract
Background: The prevalence of diabetes has been increasing, imposing
massive costs on nations. Diet and physical activity are recommended for
diabetes management. Evidence suggests theory-based interventions are
more efficacious than non-theory approaches. This study aimed to test
the effectiveness of an integrated theoretical model-based intervention
to encourage compliance for low-fat food consumption, carbohydrate
counting, and physical activity in adults with type 2 diabetes. Methods:
A 4-week parallel randomized control trial was conducted in Iran. Data
were collected using a self-report questionnaire at baseline and 8-weeks
post-intervention. This survey assessed the Theory of Planned Behaviour
(TPB) constructs of attitude, subjective norm (others’ approval), and
perceived behavioural control (PBC). We also assessed risk perceptions
(motivational) and planning (volitional) from the Health Action Process
Approach (HAPA). Furthermore, weight, body mass index, triglyceride
(TG), and LDL-cholesterol were measured. Results: For both low-fat food
consumption and physical activity, only planning revealed a significant
improvement over time for intervention rather than control participants
(F=8.78, p≤0.001 for low-fat vs. F=11.26, p≤0.001 for physical
activity). For carbohydrate counting, significant effects were found for
behavior (F=4.37, p=0.03), intention (F=8.14, p≤0.001), PBC (F=7.52,
p≤0.001), and planning (F=4.54, p=0.03), reflecting improvements over
time in the intervention participants compared to controls. Further, the
effects of the intervention on behavior were partially mediated via
participants’ degree of planning (B=0.10, SE=0.06, CI=0.01 to 0.26). The
serum TG level was significantly reduced from pre to post-intervention
for intervention rather than for control participants (F=18.69,
p≤0.001). Conclusions: This intervention was promising for carbohydrate
counting but did not show improvements for low-fat diet nor physical
activity. Given the improvement in psychological measures and
self-reported behaviour for carbohydrate counting, coupled with the
findings for TG, future research is needed to demonstrate longer-term
improvements. Current theory-based educational strategies can be adopted
for the management of carbohydrate intake in diabetes.