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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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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.  Home  Privacy Policy | Accessibility CDC Home | Search | Health Topics A-Z This page last reviewed October 25, 2011 Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion United States Department of Health and Human Services