Understanding the environmental issues in diabetes self-management education research: a reexamination of 8 studies in community-based settings

Ann Intern Med. 2004 Jun 1;140(11):964-71. doi: 10.7326/0003-4819-140-11-200406010-00038.


Eight studies included in a recent systematic review of the efficacy of diabetes self-management education were qualitatively reexamined to determine the presence of theoretical frameworks, methods used to ensure cultural appropriateness, and the quality of the instrument. Theoretical frameworks that help to explain complex pathways that produce health outcomes were lacking; culture indices were not incorporated into diabetes self-management education; and the instruments used to measure outcomes were inadequate. We provide recommendations to improve research on diabetes self-management education in community settings through use of a contextual framework that encourages targeting multiple levels of influence--individual, family, organizational, community, and policy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Community Health Services / standards*
  • Culture
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy*
  • Humans
  • Outcome Assessment, Health Care
  • Patient Education as Topic*
  • Self Care*