Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood

R E S EARCH AR TIC L E Open Access

Effectiveness of PRECEDE model for health

education on changes and level of control of

HbA1c, blood pressure, lipids, and body mass

index in patients with type 2 diabetes mellitus

Miguel A Salinero-Fort1*†

, Enrique Carrillo-de Santa Pau3†

, Francisco J Arrieta-Blanco2

, Juan C Abanades-Herranz3

,

Carmen Martín-Madrazo3

, Berta Rodés-Soldevila1 and Carmen de Burgos-Lunar4

Abstract

Background: Individual health education is considered to be essential in the overall care of patients with type 2

diabetes (DM2), although there is some uncertainty regarding its metabolic control benefits. There have been very few

randomized studies on the effects of individual education on normal care in DM2 patients with a control group, and

none of these have assessed the long-term results. Therefore, this study aims to use this design to assess the effectiveness

of the PRECEDE (Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation) education model in

the metabolic control and the reduction of cardiovascular risk factors, in patients with type 2 diabetes.

Methods: An open community effectiveness study was carried out in 8 urban community health centers in the

North-East Madrid Urban Area (Spain). Six hundred patients with DM2 were randomized in two groups: PRECEDE

or conventional model for health promotion education. The main outcome measures were glycated hemoglobin

A1c, body mass index (BMI), blood pressure, lipids and control criteria during the 2-year follow-up period.

Results: Glycated hemoglobin A1c and systolic blood pressure (SBP) levels decreased significantly in the PRECEDE

group (multivariate analysis of covariance, with baseline glycated hemoglobin A1c, SBP, and variables showing

statistically significant differences between groups at baseline visits). The decrease levels in diastolic blood pressure

(DBP), triglycerides and LDL cholesterol were nonsignificant. PRECEDE increased compliance in all control criteria,

except for LDL cholesterol. BMI did not change during the study in either of the two models analyzed.

Conclusions: PRECEDE health education model is a useful method in the overall treatment in patients with type 2

diabetes, which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in

all the control criteria, except for LDL cholesterol.

Trial registration number: ClinicalTrials.gov NCT01316367

Background

Type 2 diabetes mellitus (DM2) is one of the chronic

diseases that have increased in prevalence and inci￾dence rates in recent years [1], and some authors con￾sider it as the epidemic of the 21st century [2]. It is

also associated with premature morbidity and

mortality [3,4] as well as with an increase in health￾care costs [5].

Individual health education is considered to be essen￾tial in the overall care of patients with DM2, although

there is some uncertainty regarding its metabolic control

benefits. The PRECEDE (Predisposing, Reinforcing,

Enabling, Causes in Educational Diagnosis, and Evalua￾tion) model developed by Green and Kreuter [6] is one

of the different educational models that focus on factors

influencing health-related behavior, based on the rela￾tionship between the health professional and the patient,

* Correspondence: [email protected]

† Contributed equally 1

Fundación Investigación Biomédica. Hospital Carlos III. SERMAS. Madrid.

Spain

Full list of author information is available at the end of the article

Salinero-Fort et al. BMC Public Health 2011, 11:267

http://www.biomedcentral.com/1471-2458/11/267

© 2011 Salinero-Fort et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative

Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and

reproduction in any medium, provided the original work is properly cited.