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Health Extension for Diabetes: Development, Implementation, and Effectiveness of a Community-Based Diabetes

Windsor Westbrook Sherrill1, Luke C Hall1,2, Samantha Kanny1

  • 1Department of Public Health Sciences, Clemson University College of Behavioral, Social and Health Sciences, Clemson, SC, USA.

Public Health Reports (Washington, D.C. : 1974)
|November 24, 2025
PubMed
Summary
This summary is machine-generated.

The Health Extension for Diabetes (HED) program significantly improved diabetes self-management, quality of life, and health behaviors in rural participants. This community-based support model is scalable and sustainable for diabetes care.

Keywords:
RE-AIM frameworkcommunity-based interventiondiabetes self-management supportimplementation sciencepreventive medicine

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Area of Science:

  • Public Health
  • Community Health
  • Diabetes Management

Background:

  • Community-based programs are crucial for managing chronic diseases like diabetes.
  • The Health Extension for Diabetes (HED) program utilizes trained rural agents for diabetes self-management support.
  • Evaluating HED through the RE-AIM framework provides insights into its real-world application.

Purpose of the Study:

  • To evaluate the Health Extension for Diabetes (HED) program using the RE-AIM framework.
  • To assess the program's Reach, Effectiveness, Adoption, Implementation, and Maintenance.
  • To determine the program's impact on diabetes self-management and health outcomes.

Main Methods:

  • Longitudinal evaluation of 1526 participants from 2018-2024.
  • Pre- and postsurveys measured knowledge, self-efficacy, and health behaviors at baseline, 1 year, and 2 years.
  • Paired-sample t-tests analyzed significant changes in outcomes.

Main Results:

  • 94% graduation rate indicates high program engagement.
  • Significant improvements observed in quality of life, diet, exercise, glucose testing, and foot care.
  • Increases in diabetes knowledge and self-efficacy, alongside reductions in weight, BMI, and HbA1c.

Conclusions:

  • The HED program demonstrates a scalable and sustainable model for community-based diabetes self-management.
  • Key implementation strategies identified through RE-AIM evaluation can guide future program expansion.
  • HED effectively supports rural populations in managing their diabetes.