Using the transtheoretical model to enhance self-management activities in patients with type 2 diabetes : a systematic review

Abstract

Objective: The objective of this article is to present a review of the literature focusing on the use of the TTM in improving self-management activities in patients with type 2 diabetes. Self-management activities include following a healthier diet, exercising more regularly, enhanced medication adherence and targeting outcomes such as reduction in glycosylated haemoglobin (HbA1c). Methods: PubMed, Medline, ScienceDirect and Cochrane databases were searched using predefined terms related to TTM interventions for patients with type 2 diabetes. All study designs were included. The methods used for this review followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-analysis). The systematic search was conducted between February and May 2015. Two reviewers independently assessed the relevance of the identified abstracts, extracted data and undertook quality analysis. Key findings: Ten studies met the criteria for inclusion in the review. All studies demonstrated some positive self-management outcomes resulting from implementing the TTM intervention. In six studies, the patients reached the action or maintenance stage in the TTM cycle after the TTM intervention. Moreover, the TTM was able to help patients follow a healthier diet (n = 5) and exercise more (n = 3), and it resulted in a reduction in HbA1c (n = 4). The impact of TTM on medication adherence was not apparent. Conclusions: The findings from this systematic review provide evidence that TTM interventions are effective in promoting exercise, encouraging participants to pursue a healthier diet and lowering HbA1c levels, but the effect on medication adherence has not been widely studied among patients with type 2 diabetes.