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Emerging Infectious Diseases Journal


Volume 5: No. 4, October 2008

The National Diabetes Education Program Evaluation Framework: How to Design an Evaluation of a Multifaceted Public Health Education Program

The conceptual framework begins with Program Resources and Population Characteristics: Program Resources are funds from the National Institutes of Health and the Centers for Disease Control and Prevention, as well as Partnerships. The Population Characteristics are in two categories: Health Care Professionals (physicians, physician assistants, nurse practitioners, diabetes educators, and dietitians) and Individuals (people with diabetes; their families; people at risk for diabetes; minority populations such as African Americans, Hispanic/Latinos, American Indian and Alaska Natives, and Asian Americans and Pacific Islanders; older adults; and children).

The Program Resources and Population Characteristics influence Program Activities, which include the following activities:

  • Promote the importance and benefits of diabetes control using the Control Your Diabetes. For Life. message, through mass media and partner organization activities
  • Launch and implement the diabetes and cardiovascular disease campaign, Be Smart About your Heart. Control the ABCs of Diabetes: A1c, Blood Pressure and Cholesterol
  • Translate and promote the Diabetes Prevention Program clinical trial findings — Small Steps. Big Rewards. Prevent Type 2 Diabetes

The Program Activities lead to the Process Goals in these ways:

  • Develop and support partnerships
  • Develop and promote public service announcements
  • Develop and implement ongoing diabetes awareness and education activities
  • Identify, collect, develop, and disseminate educational tools and resources
  • Develop and implement community interventions
  • Promote a multidisciplinary team approach for caring for people with diabetes
  • Develop, translate, and disseminate more educational materials
  • Produce more press releases
  • Actively promote Web site

The Process Goals lead to the Intermediate Goals, which include the following:

  • Increase awareness of the seriousness of diabetes, its risk factors, and strategies for preventing diabetes and its complications among at-risk groups
  • Improve understanding about diabetes and its control and promote better self-management behaviors among people with diabetes
  • Improve health care providers' understanding of diabetes and its control and promote an integrated approach to care
  • Promote health care policies that improve the quality of and access to diabetes care
  • Reduce disparities in health among racial and ethnic populations disproportionately affected by diabetes

The Intermediate Goals lead to the Long-Term Goals:

  • Improve the treatment and health outcomes of people with diabetes
  • Promote early diagnosis
  • Prevent the onset of diabetes

Figure 1. National Diabetes Education Program Conceptual Framework.

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The Program Strategies include the following:

  • Develop and implement ongoing diabetes awareness and education activities
  • Identify, develop, and disseminate educational tools and resources for people with diabetes and those at risk, including materials that address the needs of special populations
  • Disseminate guiding principles that promote quality diabetes care
  • Promote policies and activities to improve the quality of and access to diabetes care
  • Create program partnerships with other organizations concerned about diabetes and the health status of their constituents

There are 3 types of outcomes for these Program Strategies. The first type of outcome is to Increase Knowledge and Understanding of these key points about diabetes:

  • Risk factors for diabetes
  • Complications of diabetes
  • Risk factors for cardiovascular disease (the ABCs of diabetes — A is for hemoglobin A1c, B is for blood pressure, and C is for cholesterol)
  • Diabetes as a controllable chronic disease
  • Treatment goals
  • Self-management steps
  • Self-monitoring and hemoglobin A1c blood glucose goals
  • Importance of losing weight, increasing physical activity, and/or taking medication to control diabetes

The second type of outcome is to Influence Attitudes/Beliefs, which results in the following:

  • Increased self-empowerment to control diabetes
  • Increased self-efficacy to adopt key self-management steps
  • Increased perceptions of severity of diabetes
  • Increased perceptions of susceptibility to complications
  • Decreased fatalism
  • Increased perceived benefits of control outweighing barriers

The third type of outcome is Increased Frequency of the following Behaviors:

  • Talking with health care provider about diabetes control
  • Setting goals
  • Creating action plans
  • Monitoring progress
  • Following an individualized healthy eating plan
  • Engaging in regular physical activity
  • Self-monitoring blood glucose (SMBG) levels
  • Adhering to medication regimen
  • Maintaining regular check-ups and visits to health care team
  • Increased use of Medicare benefits related to diabetes care

The Intermediate Outcomes are the following:

  • Achieve/maintain healthy weight
  • SMBG levels in the target range
  • Hemoglobin A1c levels below 7%
  • Blood pressure below 130/80 mm Hg
  • Low-density lipoprotein cholesterol below 100 mg/dL

The Long-Term Outcomes are the following:

  • Prevention of blindness, kidney disease, amputations, and other microvascular complications
  • Prevention of cardiovascular disease and cardiovascular disease complications

Figure 2. Strategies and Outcomes in Glucose Control.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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