Outcomes of and for diabetes education research.

PURPOSE: The purpose of this paper is to review outcome measures used to evaluate diabetes self-management education and make recommendations for future research.
METHODS: Three perspectives were used: (1) the frequency with which different measures were collected prior to 1990 was compared with a sample of the 1997 to 1999 literature, (2) a multilevel pyramid model of psychosocial-environmental factors was used to evaluate the level of outcomes assessed, and (3) the RE-AIM evaluation framework was used to assess the public health impact of studies reported in the literature.
RESULTS: Knowledge and HbA1c measures are often collected to the exclusion of other, possibly more appropriate outcomes. Research has focused almost exclusively on individual or family level outcomes and paid little attention to effects at systems levels, such as neighborhoods, communities, or healthcare systems. More recent studies have been evaluating the reach of interventions, but more practice-oriented research needs to be conducted with representative patients, providers, and settings.
CONCLUSIONS: Much has been learned about the efficacy of diabetes self-management and about measurement issues. Future research should now focus on effectiveness and generalization issues.