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Volume 5:
No. 4, October 2008
TOOLS AND TECHNIQUES
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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