human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels BACKGROUND The purpose of this study was to determine the effects of educational program based on the BASNEF ( Belief , Attitude , Subjective Norm , and Enabling Factors ) Model on eye care among patients with insulin independent diabetes mellitus in Shiraz City , Fars Province , Iran . METHODS We enrolled 100 patients with non-insulin independent diabetes mellitus ( Type II ) fulfilling the inclusion criteria of this experimental study . The participants were r and omly divided into two groups , one experimental , and one control group . All groups completed the question naires based on the BASNEF Model , a checklist related to patient 's practice including patients ' HbA1c and FBS levels , the pre-test results of an ophthalmologist 's eyes examination and the results of three months follow-up . The experimental group participated in eight educational sessions during the interventional . The data analysis used including chi square-test , t-test , and ANOVA . RESULTS The knowledge and all BASNEF Model components were significantly increased in the experimental group compared to the control group after intervention . In addition , behavioral eye care , such as physical activities , regular taking medicine , having eye examination , FBS checking , having appropriate diet , HbA1c level , and fasting blood sugar levels improved significantly among the experimental group compared to the control group . CONCLUSION Applying the BASNEF Model is very effective for developing an educational program for diabetic patients , in order to control their blood sugar and enhancing behavioral eye care . Besides such programs , follow up education on controlling and monitoring is highly recommended PURPOSE Few culturally competent health programs have been design ed for Mexican Americans , a group that bears a disproportionate burden of Type 2 diabetes . In Starr County , a Texas-Mexico border community , investigators design ed and tested a culturally competent intervention aim ed at improving the health of this target population . The purpose of this article is to describe the development process of this diabetes education and support group intervention . METHODS The development stages were ( 1 ) community assessment , ( 2 ) intervention design , ( 3 ) selection or development of outcomes , ( 4 ) pilot testing , and ( 5 ) a r and omized clinical investigation . RESULTS Focus group participants identified knowledge deficits regarding diabetes and self-management strategies , and suggested characteristics of an effective intervention for Mexican Americans . Outcome measures included metabolic control indicators , a newly developed knowledge instrument , and an existing health belief instrument . Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population . CONCLUSIONS Developing successful diabetes interventions for minority groups requires a number of stages , careful planning , assessment of cultural characteristics of the target population , and a systematic approach to implementation AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention BACKGROUND : Patients have a major role in the control and treatment of type 2 diabetes . So , knowledge of different aspects of this disease especially diet therapy is very important for these patients . This study was conducted to determine the effectiveness of the Health Belief Model ( HBM ) on nutrition education in type 2 diabetic patients . METHOD : Eighty eight type 2 diabetic patients attending Iranian Diabetes Association seminars were r and omly selected to participate in the study ( 44 in intervention group and 44 in control group ) . The intervention was consisted of two educational sessions each one for 80 minutes . Data were collected by a vali date d and reliable question naire ( 58 questions ) before intervention and one month after intervention . RESULTS : After intervention , knowledge scores increased in the intervention group compared to the control group ( Mean differences in the intervention and test group : 22.68 ± 15.90 vs - 2.27 ± 17.30 , P < 0.001 ) . Perceived susceptibility increased significantly in the intervention group compared to the control group ( 27.5 ± 18.5 vs 3.9 ± 17.2 , P < 0.001 ) . The result was the same for perceived severity , perceived threatened and perceived benefits ( P < 0.001 ) . In contrast perceived barriers reduced in the intervention group compared to the control diet ( -14.7 ± 13.3 vs 0.9 ± 13.9 , P < 0.001 ) . In the intervention group , behavior grade s increased more than control group ( 34.61 ± 14.93 vs -0.23 ± 8.52 , P < 0.001 ) . CONCLUSION : The efficacy of the health belief model in nutritional education to the diabetic patients was confirmed in the present study BACKGROUND : This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center ( IEMRC ) from April 2008 to January 2009 . METHODS : In a r and omized controlled clinical trial , a total of 172 patients with uncontrolled type 2 diabetes were selected and r and omly allocated into control and intervention groups . After taking informed written consent , the intervention group received an educational program about oral anti-hyperglycemic medications , adherence , diabetes dairy log and pill box usage . Patient 's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist .  Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups . RESULTS : After a three months follow-up , mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group ( p < 0.001 ) . CONCLUSIONS : This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics . The results suggest the benefits of adding adherence education to the diabetic education programs AIMS To explore the impact of pictorial image and teach back educational strategies on knowledge , adherence to medication and diet among patients with type 2 diabetes and low health literacy in Saqqez , Iran . METHODS In this r and omized controlled trial , 127 patients with type 2 diabetes who had low health literacy were r and omly allocated into three arms of the study ( pictorial image , teach back , and control groups ) . The two intervention groups received education within three weekly sessions , each lasting 20 min . The level of functional health literacy in adults ( TOFHLA ) , diabetes knowledge , and adherence to medication and diet were measured and compared in the three groups before and six weeks after the interventions . We used intention to treat analysis . Data were analyzed using ANOVA and Paired t test . RESULTS Mean scores of knowledge , adherence to medication and diet revealed significant differences between two intervention groups and control group ( P<0/001 ) six weeks after intervention . CONCLUSIONS Both educational strategies increased knowledge , as well as adherence to medications and diet among patients with type 2 diabetes and low health literacy . Both educational strategies seem to be effective for patients with low health literacy and are recommended to be used according to patients ' conditions The prevalence of diabetes in India has grown over the past decade . Diabetic patients develop complications due to poor awareness regarding the disease and inadequate glycemic control . Patient education is the most effective way to lessen the complications of diabetes and its management . A total of 207 ( 85 males and 122 females ) type 2 diabetes mellitus patients were enrolled and r and omized into test and control groups . Patients in the test group received counseling at each visit and information leaflets from the pharmacist ; the control group patients received counseling and information leaflets only at the end of the study . A vali date d knowledge , attitude , and practice ( KAP ) question naire was administered to both test and control group patients at baseline and at final follow-up to assess awareness regarding disease management . Glucose and lipid levels were also evaluated at baseline and final follow-up in both the groups . At the end of the study , the KAP score of test group patients improved significantly ( P<0.0001 ) , whereas no significant changes were observed in control group patients . The postpr and ial blood glucose ( PPBG ) levels decreased significantly in the test group . Total cholesterol ( TC ) , triglycerides ( TGL ) , and low density lipoprotein levels ( LDL ) also showed a decrease in the test group . Thus , our study reveals that pharmacist counseling might be an important element in diabetes management programs Background Research ers believe that most of diabetic patients are not necessarily aware of the role of exercises , especially jogging in controlling their disease . The purpose of this study was to evaluate the effect of educational program and jogging based on health belief model ( HBM ) on sugar control in type 2 diabetic patients . Methods One hundred diabetic ( type 2 ) patients were involved in this prospect i ve quasi-experimental interventional study . Patients were r and omly divided into two groups of experimental and control . Data was collected using a question naire based on the HBM model , a check list for patient`s practice s and a check list for recording the patient`s hemoglobin ( HbA1C ) and fasting blood sugar ( FBS ) levels . Results Our findings indicated that after intervention , there was a significant difference between the mean score of the HBM model variables ( susceptibility , severity , benefit and perceived obstacles , ) in the experimental group compared to the control group . Additionally , behavioral jogging , level of HbA1C and FBS levels improved significantly among the experimental group when compared to the control group . Conclusion Applying the HBM model was found to be a very effective means for developing an educational program of jogging for diabetics , in order to control their blood sugar Background Diabetes has become a major public health problem in China . Support of patient self-management is a key component of effective diabetes care and improved patient outcomes . A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999 . However , the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai . This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors , self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai . Methods 208 patients with 
    Output:
    
agent
Interventions were generally effective on behavior change and patients ’ glycemic control in the short term ( ≤9 months ) .
Conclusions The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels BACKGROUND The purpose of this study was to determine the effects of educational program based on the BASNEF ( Belief , Attitude , Subjective Norm , and Enabling Factors ) Model on eye care among patients with insulin independent diabetes mellitus in Shiraz City , Fars Province , Iran . METHODS We enrolled 100 patients with non-insulin independent diabetes mellitus ( Type II ) fulfilling the inclusion criteria of this experimental study . The participants were r and omly divided into two groups , one experimental , and one control group . All groups completed the question naires based on the BASNEF Model , a checklist related to patient 's practice including patients ' HbA1c and FBS levels , the pre-test results of an ophthalmologist 's eyes examination and the results of three months follow-up . The experimental group participated in eight educational sessions during the interventional . The data analysis used including chi square-test , t-test , and ANOVA . RESULTS The knowledge and all BASNEF Model components were significantly increased in the experimental group compared to the control group after intervention . In addition , behavioral eye care , such as physical activities , regular taking medicine , having eye examination , FBS checking , having appropriate diet , HbA1c level , and fasting blood sugar levels improved significantly among the experimental group compared to the control group . CONCLUSION Applying the BASNEF Model is very effective for developing an educational program for diabetic patients , in order to control their blood sugar and enhancing behavioral eye care . Besides such programs , follow up education on controlling and monitoring is highly recommended PURPOSE Few culturally competent health programs have been design ed for Mexican Americans , a group that bears a disproportionate burden of Type 2 diabetes . In Starr County , a Texas-Mexico border community , investigators design ed and tested a culturally competent intervention aim ed at improving the health of this target population . The purpose of this article is to describe the development process of this diabetes education and support group intervention . METHODS The development stages were ( 1 ) community assessment , ( 2 ) intervention design , ( 3 ) selection or development of outcomes , ( 4 ) pilot testing , and ( 5 ) a r and omized clinical investigation . RESULTS Focus group participants identified knowledge deficits regarding diabetes and self-management strategies , and suggested characteristics of an effective intervention for Mexican Americans . Outcome measures included metabolic control indicators , a newly developed knowledge instrument , and an existing health belief instrument . Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population . CONCLUSIONS Developing successful diabetes interventions for minority groups requires a number of stages , careful planning , assessment of cultural characteristics of the target population , and a systematic approach to implementation AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention BACKGROUND : Patients have a major role in the control and treatment of type 2 diabetes . So , knowledge of different aspects of this disease especially diet therapy is very important for these patients . This study was conducted to determine the effectiveness of the Health Belief Model ( HBM ) on nutrition education in type 2 diabetic patients . METHOD : Eighty eight type 2 diabetic patients attending Iranian Diabetes Association seminars were r and omly selected to participate in the study ( 44 in intervention group and 44 in control group ) . The intervention was consisted of two educational sessions each one for 80 minutes . Data were collected by a vali date d and reliable question naire ( 58 questions ) before intervention and one month after intervention . RESULTS : After intervention , knowledge scores increased in the intervention group compared to the control group ( Mean differences in the intervention and test group : 22.68 ± 15.90 vs - 2.27 ± 17.30 , P < 0.001 ) . Perceived susceptibility increased significantly in the intervention group compared to the control group ( 27.5 ± 18.5 vs 3.9 ± 17.2 , P < 0.001 ) . The result was the same for perceived severity , perceived threatened and perceived benefits ( P < 0.001 ) . In contrast perceived barriers reduced in the intervention group compared to the control diet ( -14.7 ± 13.3 vs 0.9 ± 13.9 , P < 0.001 ) . In the intervention group , behavior grade s increased more than control group ( 34.61 ± 14.93 vs -0.23 ± 8.52 , P < 0.001 ) . CONCLUSION : The efficacy of the health belief model in nutritional education to the diabetic patients was confirmed in the present study BACKGROUND : This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center ( IEMRC ) from April 2008 to January 2009 . METHODS : In a r and omized controlled clinical trial , a total of 172 patients with uncontrolled type 2 diabetes were selected and r and omly allocated into control and intervention groups . After taking informed written consent , the intervention group received an educational program about oral anti-hyperglycemic medications , adherence , diabetes dairy log and pill box usage . Patient 's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist .  Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups . RESULTS : After a three months follow-up , mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group ( p < 0.001 ) . CONCLUSIONS : This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics . The results suggest the benefits of adding adherence education to the diabetic education programs AIMS To explore the impact of pictorial image and teach back educational strategies on knowledge , adherence to medication and diet among patients with type 2 diabetes and low health literacy in Saqqez , Iran . METHODS In this r and omized controlled trial , 127 patients with type 2 diabetes who had low health literacy were r and omly allocated into three arms of the study ( pictorial image , teach back , and control groups ) . The two intervention groups received education within three weekly sessions , each lasting 20 min . The level of functional health literacy in adults ( TOFHLA ) , diabetes knowledge , and adherence to medication and diet were measured and compared in the three groups before and six weeks after the interventions . We used intention to treat analysis . Data were analyzed using ANOVA and Paired t test . RESULTS Mean scores of knowledge , adherence to medication and diet revealed significant differences between two intervention groups and control group ( P<0/001 ) six weeks after intervention . CONCLUSIONS Both educational strategies increased knowledge , as well as adherence to medications and diet among patients with type 2 diabetes and low health literacy . Both educational strategies seem to be effective for patients with low health literacy and are recommended to be used according to patients ' conditions The prevalence of diabetes in India has grown over the past decade . Diabetic patients develop complications due to poor awareness regarding the disease and inadequate glycemic control . Patient education is the most effective way to lessen the complications of diabetes and its management . A total of 207 ( 85 males and 122 females ) type 2 diabetes mellitus patients were enrolled and r and omized into test and control groups . Patients in the test group received counseling at each visit and information leaflets from the pharmacist ; the control group patients received counseling and information leaflets only at the end of the study . A vali date d knowledge , attitude , and practice ( KAP ) question naire was administered to both test and control group patients at baseline and at final follow-up to assess awareness regarding disease management . Glucose and lipid levels were also evaluated at baseline and final follow-up in both the groups . At the end of the study , the KAP score of test group patients improved significantly ( P<0.0001 ) , whereas no significant changes were observed in control group patients . The postpr and ial blood glucose ( PPBG ) levels decreased significantly in the test group . Total cholesterol ( TC ) , triglycerides ( TGL ) , and low density lipoprotein levels ( LDL ) also showed a decrease in the test group . Thus , our study reveals that pharmacist counseling might be an important element in diabetes management programs Background Research ers believe that most of diabetic patients are not necessarily aware of the role of exercises , especially jogging in controlling their disease . The purpose of this study was to evaluate the effect of educational program and jogging based on health belief model ( HBM ) on sugar control in type 2 diabetic patients . Methods One hundred diabetic ( type 2 ) patients were involved in this prospect i ve quasi-experimental interventional study . Patients were r and omly divided into two groups of experimental and control . Data was collected using a question naire based on the HBM model , a check list for patient`s practice s and a check list for recording the patient`s hemoglobin ( HbA1C ) and fasting blood sugar ( FBS ) levels . Results Our findings indicated that after intervention , there was a significant difference between the mean score of the HBM model variables ( susceptibility , severity , benefit and perceived obstacles , ) in the experimental group compared to the control group . Additionally , behavioral jogging , level of HbA1C and FBS levels improved significantly among the experimental group when compared to the control group . Conclusion Applying the HBM model was found to be a very effective means for developing an educational program of jogging for diabetics , in order to control their blood sugar Background Diabetes has become a major public health problem in China . Support of patient self-management is a key component of effective diabetes care and improved patient outcomes . A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999 . However , the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai . This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors , self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai . Methods 208 patients with 
    Output:
    