Effectiveness of the Health Extension for Diabetes Program, a DSMS Program Delivered In-Person and Online: A Quasiexperimental Comparative Study

TL;DR

This study compares online and in-person diabetes self-management programs and finds both are effective, but serve different demographics.

Contribution

The study demonstrates that online and in-person delivery of a diabetes self-management program are equally effective in improving health outcomes.

Findings

Both online and in-person HED delivery improved biometric and diabetes outcomes.

Online participants showed significantly higher diabetes knowledge scores.

Demographic differences highlight the need for multiple delivery options to reach diverse populations.

Abstract

Diabetes is a complex, prevalent condition. Effective diabetes self-management requires knowledge, skills, and strategies to prevent or delay the onset of diabetes-related complications. This study evaluated the effectiveness of delivery methods, online versus in-person, for the 4-month-long Health Extension for Diabetes (HED) program, a self-management support program.

A quasiexperimental comparative study design assessed whether online HED delivery was as effective as in-person delivery and whether group differences affected health outcomes. Multivariate analysis of covariance (MANCOVA) was conducted to assess changes in participants' weight, BMI, HbA1c, diabetes self-efficacy, knowledge, and self-management behaviors. This study included a total of 1018 participants (online = 613; in‐person = 405). The online program was delivered synchronously via video or phone conferencing platforms, while in-person sessions occurred at a community location. Survey and biometric data were collected at baseline and upon program completion to evaluate pre- to postprogram changes.

Online HED participants were mostly White non-Hispanic, significantly younger, more educated, and had higher income than in-person participants. Regardless of the delivery modality, positive changes pre- to postprogram were seen across all biometric and diabetes outcome measures. Significant differences between delivery modalities were observed for diabetes knowledge, with individuals in online groups demonstrating significantly higher knowledge scores at both assessment points. For weight and BMI, both modalities showed significant improvements.

Online and in-person HED modalities effectively improved diabetes self-management, reaching two different demographic groups. Demographic differences between groups underscore the importance of offering multiple participation modalities to ensure accessibility and engagement across diverse populations. The HED program model, using a community-clinical linkage through Cooperative Extension, is an effective model for improving health outcomes of participants enrolled in both online and in-person DSMS programs. Future research should focus on how different participant characteristics influence engagement and long-term diabetes outcomes across delivery modalities.

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