Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Apr;35(4):699-705.
doi: 10.2337/dc11-1183. Epub 2012 Feb 14.

Examining the Psychological Pathways to Behavior Change in a Group-Based Lifestyle Program to Prevent Type 2 Diabetes

Free PMC article
Randomized Controlled Trial

Examining the Psychological Pathways to Behavior Change in a Group-Based Lifestyle Program to Prevent Type 2 Diabetes

Christine R Critchley et al. Diabetes Care. .
Free PMC article


Objective: To examine the psychological process of lifestyle change among adults at risk for type 2 diabetes.

Research design and methods: A randomized control trial in which 307 volunteers (intervention, n = 208; wait control, n = 99) diagnosed with prediabetes completed a six-session group-based intervention to promote healthier living. Participants' motivation to change, diet and exercise self-efficacy, mood, knowledge about diabetes, activity levels, healthy eating, waist circumference, and weight were assessed before and after the program.

Results: Participation in the program was associated with significant increases in healthy eating and physical activity, reductions in waist and weight, and improvements in motivation, positive mood, self-efficacy, and knowledge. Examination of the pathways to lifestyle change showed that the educational aspect of the program increased activity levels because it increased diabetes knowledge and improved mood. Eating behavior was not mediated by any of the psychological variables. Improvements in diet and physical activity were, in turn, directly associated with changes in weight and waist circumference.

Conclusions: Although the program significantly improved motivation, self-efficacy, and mood, its impact on knowledge uniquely explained the increase in physical activity. Group-based programs that are tailored to lifestyle behaviors may provide a cost-effective method of diabetes prevention, but more research is needed to explain why they improve healthy eating.


Figure 1
Figure 1
Standardized parameter estimates for baseline and final multiple mediation models explaining predictors of lifestyle and body change among adults diagnosed with prediabetes. All parameter estimates were significant at P < 0.05 unless specified. Numbers in parentheses in the final model represent parameter estimates for the model containing only knowledge as a mediator, and underlined estimates represent those for the model containing only affect as a mediator. R2, the proportion of variance explained in the dependent variable by all independent variables.

Similar articles

See all similar articles

Cited by 14 articles

See all "Cited by" articles


    1. Eriksson J, Lindström J, Valle T, et al. Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 1999;42:793–801 - PubMed
    1. World Health Organization Screening for Type 2 Diabetes, Report of a World Health Organization and International Diabetes Federation Meeting. Geneva, WHO Press, 2003
    1. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus ECDCD: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2007;25(Suppl. 1):S5–S20 - PubMed
    1. Laatikainen T, Dunbar JA, Chapman A, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health 2007;7:249 - PMC - PubMed
    1. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537–544 - PubMed

Publication types

MeSH terms