Inadequate Description of Educational and Behavior Change Theories in
Lifestyle Interventions for Type 2 Diabetes Prevention
Jens Aagaard-Hansen
1*
, Ane Høstgaard Bonde
1
, Bjarne Bruun Jensen
1
, Louise Buhl Andersen
2
, Anette Lykke Hindhede
1
and Helle Terkildsen Maindal
3
1
Steno Health Promotion Center, Steno Diabetes Center, Denmark
2
Department of Social Psychology, London School of Economics and Political Science, UK
3
Department of Public Health, Faculty of Health, Aarhus University, Denmark
*
Corresponding author: Jens Aagaard-Hansen, Steno Health Promotion Center, Steno Diabetes Center, Niels Steensens Vej 8, 2820 Gentofte, Denmark, Tel: +45
4443 3438; Fax: +45 3968 1048; E-mail: jxah@steno.dk
Rec date: Apr 26, 2014, Acc date: May 23, 2014, Pub date: May 27, 2014
Copyright: © 2014 Aagaard-Hansen J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
The aim of this article is to explore the extent to which educational and behavior change theories were adequately
described in studies aiming at postponing or preventing type 2 diabetes among individuals with prediabetes using
lifestyle interventions. This is essential in order to design effective interventions for ‘real life’ settings. A number of
databases were searched: Web of Science, PubMed, SCOPUS, Cochrane Library, Cross (MEDLINE, EMBASE,
CUCO, BIOSIS), EPPI-Centre: Database of promoting health effectiveness reviews (DoPHER) and EPPI-Centre:
The Trials Register of Promoting Health Interventions (TRoPHI). Sixteen randomized controlled trials were selected
based on the criteria of prediabetes, defined as impaired glucose tolerance and/or impaired fasting glucose and
efficacious lifestyle interventions (diet and/or physical activity). Only four trials made explicit reference to use of
educational and behavior change theories in the development of the lifestyle interventions. Another five trials
provided partial information, whereas the remaining seven did not refer to theories directly or indirectly. In order to
allow replicability and comparison, future studies should explicitly describe and/or consider use of educational and
behavior change theories in the development of lifestyle interventions.
Keywords: Behavior change; Diet; Education; Physical activity;
Prevention; Theory; Type 2 diabetes
Abbreviations:
ADA: American Diabetes Association; BMI: Body Mass Index;
CONSORT: Consolidated Standards of Reporting Trials; Credeci:
Criteria for Reporting the Development and Evaluation of Complex
Interventions in Healthcare; IFG: Impaired Fasting Glucose; IGT:
Impaired Glucose Tolerance; PA: Physical Activity; RCT:
Randomized, Controlled Trial; T2D: Type 2 Diabetes; TREND:
Transparent Reporting of Evaluation with Non-Randomized Designs;
WHO: World Health Organization
Introduction
Assessment of public health interventions should follow
methodological rigor and at the same time take into account the
complexity of implementing such interventions in real life settings.
The Medical Research Councils evaluation framework [1] has become
if not a golden standard, then a very common reference for
development of complex primary health care interventions. In parallel
to this development, researchers and editors of scientific journals have
made an effort to improve the way scientific studies are reported, e.g.
Consolidated Standards of Reporting Trials (CONSORT) [2],
Transparent Reporting of Evaluation with Non-randomized Designs
(TREND) [3] and Criteria for Reporting the Development and
Evaluation of Complex Interventions in Healthcare (CreDECI) [4].
Adequate application of behavioural science theories is essential
for effective behavior change interventions. Planning and evaluation
are key elements in developing health promotion programmes.
Theories and empirical evidence form the basis for decisions during
the planning process …. [5]. This is in line with attempts to initiate a
much needed discussion on the role of theory in health behavior
change interventions [6]. This has led to explorations of the usefulness
of self-efficacy [7], intervention mapping [5,8], health behavior theory
[9] and self-determination theory [10,11] in intervention designs.
In the field of diabetes prevention the past two decades research
has shown the efficacy of intensive lifestyle interventions (diet and
physical activity (PA)) in postponing or even preventing the onset of
type 2 diabetes among persons with prediabetes. The focus has now
shifted to effectiveness and efficiency studies exploring how
prevention interventions may be implemented in real life settings.
Numerous systematic reviews on lifestyle prevention of type 2 diabetes
[12-19] as well as many more scoping reviews have been conducted
which mostly focused on the diabetes screening methods and
outcomes rather than provision of details about the interventions used.
The present article focuses on the extent to which the use of
educational and behavior change theories in design of the
interventions was explicitly reported.
Methods
The following electronic databases were searched in order to
identify relevant literature - Web of Science, PubMed, SCOPUS,
Cochrane Library, Cross (MEDLINE, EMBASE, CUCO, BIOSIS),
EPPI-Centre: Database of promoting health effectiveness reviews
(DoPHER), EPPI-Centre: The Trials Register of Promoting Health
Interventions (TRoPHI). Variations and combinations of the
following search terms were used when searching the databases: (1)
Diabetes & Metabolism
Aagaard-Hansen et al., J Diabetes Metab 2014, 5:5
http://dx.doi.org/10.4172/2155-6156.1000375
Review Article Open Access
J Diabetes Metab
ISSN:2155-6156 JDM, an open access journal
Volume 5 • Issue 5 • 375