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Effectiveness of A Theory-based Intervention to Promote Diabetes Management Behaviours Among Adults with Type 2 Diabetes in Iran: A Randomized Control Trial
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  • Reza Daryabeygi,
  • Katherine White,
  • kurosh djafarian,
  • Sheikh Mohammed Shariful Islam,
  • Susie Cartledge,
  • Mohammad Payam Ghaffari,
  • Seyed Ali Keshavarz
Reza Daryabeygi
Deakin University
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Katherine White
Queensland University of Technology
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kurosh djafarian
Tehran University of Medical Sciences
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Sheikh Mohammed Shariful Islam
Deakin University, Deakin University
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Susie Cartledge
Flinders University
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Mohammad Payam Ghaffari
Islamic Azad University Science and Research Branch
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Seyed Ali Keshavarz
Tehran University of Medical Sciences
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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.

Peer review status:ACCEPTED

25 Sep 2020Submitted to International Journal of Clinical Practice
28 Sep 2020Submission Checks Completed
28 Sep 2020Assigned to Editor
29 Sep 2020Reviewer(s) Assigned
24 Oct 2020Review(s) Completed, Editorial Evaluation Pending
12 Dec 20201st Revision Received
14 Dec 2020Submission Checks Completed
14 Dec 2020Assigned to Editor
14 Dec 2020Reviewer(s) Assigned
29 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Jan 2021Editorial Decision: Accept