Readiness to change and clinical success in a diabetes educational program

We wanted to determine whether a simple tool characterizing readiness to change among patients before participating in a diabetes educational intervention successfully screens for patients who will achieve satisfactory clinical improvement.

Fifty patients referred to a diabetes educational center with hemoglobin A1c levels of more than 9.0% were asked four questions before participation in a diabetes educational program. Patients were categorized into precontemplation-contemplation, preparation, and action stages of readiness to change. Intensive diabetes education was offered to all participants. Hemoglobin A1c levels were measured for 24 months after the educational program.

Patients in preparation and actions stages achieved a significantly larger reduction in hemoglobin A1c levels in a shorter time than patients in the combined precontemplation-contemplation stage. Average change in hemoglobin A1c levels at 12 months was -1.06 +/- 1.80 (P = .17) for the precontemplation-contemplation stage, -1.82 +/- 1.84 (P = .006) for the preparation stage, and -2.56 +/- 2.12 (P = .0006) for the action stage. Patients had significantly more hemoglobin A1c measurements in the preparation stage (4.63 +/- 2.42, P = .036) and the action stage (4.94 +/- 2.38, P = .013) than patients in the precontemplation-contemplation stage (3.00 +/- 1.22) during the 24-month study.

In this small population, stage of change as determined by a simple clinical tool was significantly associated with clinical improvement in hemoglobin A1c levels at 3 months after an educational intervention. Significant differences in clinical improvement between groups persisted for at least 12 months. This tool could be used to tailor the most effective clinical diabetes interventions for patients and to address the needs of patients in a more targeted manner.