Abstract
A majority of diabetes self-management programs have been shown to improve knowledge, attitude, practice, and health care outcomes. However, in the literature the underlying causal mechanisms for the improvement attributable to health education interventions have not been systematically explored, especially to show how diabetes educational intervention may affect diabetes care outcomes. The purpose of this scientific review is to identify the underlying causal mechanisms responsible for improved knowledge, attitude, preventive practice and outcomes, so that educational interventions can be tailored efficiently and effectively to patients who are most likely to benefit from self-care management. The review examines multiple causes of the variation in each of the clinical or health outcomes such as glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDLC), functional capacity (FC), and poor perceived health (PPH).We include behavioral theories relevant to changing diabetes patients’ behaviors: 1) the health belief model, 2) the theory of planned behavior, 3) social cognitive theory, 4) the trans-theoretical model of stages of change, and 5) the patient empowerment model. These theories seek to identify the determinants or predictors of health behavior and change. Future research on diabetes care could be benefited from employing information technology and self-monitoring devices.