Educational Intervention for Management of Diabetes in Patients With Hypertension

Variables measured across the 3 dimensions include nutrition, exercise, stress control, interpersonal relationships, self-monitoring, treatment adherence, and blood pressure.

Educational intervention based on the PRECEDE model on lifestyle skills, diabetes self-management, and hypertension control is an effective noninvasive method to complement other treatments for patients with type 2 diabetes, according to study results published in Endocrine Disorders.

Unhealthy behaviors and lifestyle choices can hinder diabetes management and exacerbate complications such as hypertension. Researchers claim that, “Poor lifestyle choices, inappropriate self-management, and the increase of comorbidities such as hypertension persist despite several studies on diabetes education.” The PRECEDE model (Predisposing, Reinforcing, Enabling Constructs in Educational, Diagnosis, and Evaluation) applies attitudes, beliefs, and values to training programs that enable and reinforce diabetes-related behavioral changes. This study evaluated the effect of the PRECEDE model’s intervention on lifestyle skills, self-management, and hypertension outcomes in patients with type 2 diabetes.

Poor lifestyle choices, inappropriate self-management, and the increase of comorbidities such as hypertension persist despite several studies on diabetes education.

A total of 300 patients with type 2 diabetes and hypertension participated in this clinical trial. The researchers randomly assigned participants 1:1 to receive either 10 PRECEDE-based training sessions on lifestyle skills, self-management, and hypertension (intervention group) or 4-hour educational sessions once the study was over (control group). Before and after the intervention, participants completed questionnaires that captured measures based on the 3 training dimensions:

  • Lifestyle: Nutrition, physical exercise, responsibility, stress control, interpersonal relationships, and self-actualization.
  • Diabetes self-management: Self-integration, self-regulation, interaction with health professionals, self-monitoring, and adherence to the treatment regimen
  • Hypertension: Systolic hypertension, diastolic hypertension

At baseline, patients in the intervention and control groups had similar mean ages, mean duration of diabetes, education levels, monthly household income, and family history of diabetes. There were no significant differences between the groups in knowledge, attitude, self-efficacy, enabling, and strengthening factors. After 3 months, patients in the intervention group experienced significantly higher mean scores in the lifestyle and diabetes self-management dimensions (P <.001) and significant reductions in their mean systolic and diastolic blood pressure measures (P <.001).

“Following the intervention,” according to the authors, “there were substantial differences between the intervention group and the control group in terms of knowledge, the most significant predisposing factor in the PRECEDE model.” The authors suggest that public health educators might consider the PRECEDE model to be a noninvasive, medication-free way to educate and support patients and that PRECEDE model should be viewed as a supplement to, not a substitution for, diabetes treatment for patients who also cope with hypertension.


Jeihooni AK, Sobhani A, Harsini PA, Amirkhani M. Effect of educational intervention based on PRECEDE model on lifestyle modification, self-management behaviors, and hypertension in diabetic patients. Published online January 6, 2023. Endocrine Disorders. doi:10.1186/s12902-023-01264-y.