Abstract
Diabetes self-management programs have advocated the need to improve knowledge, attitude, and practice of self-care. However, many studies fail to explain how health education works for lack of causal specifications. This study formulates an appropriate framework, specifies the relationships among knowledge, attitude, practice and outcomes (KAP-O), and examines the factors influencing variations in the glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDLC), functional capacity (FC), and poor perceived health (PPH). Health behavioral theories were reviewed. Relevant studies on the knowledge, attitude, practice, and health care outcomes were reviewed to support a theoretical framework and to deduce testable hypotheses. General findings suggest the support of a positive effect of health educational interventions on improved Diabetics’ knowledge, attitude, and preventive practice, and health care outcomes. Initially, four causally specified hypotheses were deduced: 1) Health educational intervention directly improves knowledge; 2) health educational intervention directly improves attitude; 3) health educational intervention directly improves preventive practice; and 4) health educational intervention directly lowers A1C and LDLC, improves FC), and decreases PPH. Furthermore, the causal mechanisms of improved outcomes from a behavioral perspective also suggest two additional research hypotheses for further evaluation. They include: 1) health educational intervention may indirectly improve preventive practice via knowledge and attitude improvements; and 2) health educational intervention also indirectly improves outcomes via changing knowledge, attitude, and self-care practice. The causal mechanisms in improved diabetes outcomes should be empirically validated in clinical trial studies, using structural equation modeling with multi-centers, multiple providers and a diverse population of type 2 patients. Baseline knowledge and attitude should be continuously improved during study period of one to two years. The study should assess outcomes more than four times over the study period. The study will enable discovery of whether knowledge or attitude has a more dominant influence on preventive practice and thus on diabetes care outcomes.