Applying the Stages of Change model to Type 2 diabetes care in Trinidad: A randomised trial
Open accessAbstract
Objective: To improve glycaemic control among Type 2 diabetics using patient-physician consultations guided by the Stages of Change (SOC) model. Design and Methods: A randomised trial was conducted. After ensuring concealment of allocation, Type 2 diabetics were randomly assigned to receive the intervention or the control. The intervention consisted of identifying each patient's Stage of Change for managing their diabetes by diet, exercise and medications, and applying personalised, stage-specific care during the patient-physician consultations based on the SOC model. Patients in the control group received routine care. The variables of interest were effect on glycaemic control (measured by the difference in HbA 1c levels) and patients' readiness to change (measured by identifying patients' SOC for managing their diabetes by diet, exercise and medications). Results: Participants were primarily over age 50, male and Indo-Trinidadian. Most had received only a primary school education and over 65% had a monthly income of $320 USD/month or less. Sixty-one Type 2 diabetics participated in each arm. Three patients were lost to follow-up in the intervention arm. After 48 weeks, there was an overall increase in HbA 1c of 0.52% (SE 0.17) and 1.09% (SE 0.18) for both the intervention and control groups respectively. There was a relative reduction in HbA 1c of 0.57% (95% CI 0.07, 1.07) with the intervention group compared to the control (p = 0.025). For exercise and diet there was an overall tendency for participants in the intervention arm to move to a more favourable SOC, but little change was noted with regards medication use. Conclusions: The result suggests a tendency to a worsening of glycaemic control in this population despite adopting more favourable SOC for diet and exercise. We hypothesized that harsh social conditions prevailing at the time of the study overrode the clinical intervention.
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Forty-four RCTs examined the impact of interventions on disease-specific outcomes.
“Forty four RCTs examined the impact of interventions on disease specific outcomes”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [51]
The Methods (Study design) describe one randomized trial, and the Results report its diabetes-related outcomes, including HbA1c. The paper therefore supports that an intervention was examined for a disease-specific outcome, but it does not report that forty-four RCTs did so. (LLM, conf=0.86)
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- Authors
- Partapsingh, V., Maharaj, R., & Rawlins, J.
- Affiliations
- University of the West Indies (TT)
- Corresponding author
- Maharaj, RG
- Venue
- Journal of Negative Results in BioMedicine
- Published
- 2011-10-11
- Volume
- 10
- Issue
- 1
- Pages
- 13-13
- ISSN
- 1477-5751 (ISSN-L)
- PMC
- PMC3219566
- OpenAlex
- W2109038086
- Cited by
- 30
- References
- 18
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 1 · 2021: 2 · 2020: 2 · 2019: 8 · 2018: 2 · 2016: 4 · 2015: 1 · 2014: 3 · 2012: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Negative Results in BioMedicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, stages of change, glycemic control, HbA1c, physician-patient consultation, readiness to change, diet, physical activity, antidiabetic drugs, social determinants of health, Trinidad
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Life Style, Male, Middle Aged, Self Care, Trinidad and Tobago
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