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Table 1 Details of the intervention and strategies to address the constructs in the theoretical frameworks

From: The effects of a nurse-led integrative medicine-based structured education program on self-management behaviors among individuals with newly diagnosed type 2 diabetes: a randomized controlled trial

Scheduled activities Description of intervention and strategies to address the constructs in the theoretical frameworks
Baseline assessment and goal setting • Identify the participants’ Traditional Chinese Medicine syndromes;
• Measure the participants’ health outcomes; let the participants know the results and tell them the implications (Cues to action);
• Encourage the participants to set realistic goals and the goal-obtaining evaluation intervals for themselves (Cues to action; Verbal persuasion; Performance accomplishments);
• Remind the participants of the potential consequences of setting a too easy or too hard goal (Cues to action; Verbal persuasion).
Topic-based structured education
Topic 1: Basic knowledge about diabetes • Teach the participants about the basic knowledge of the disease, including the physiological process of normal glucose metabolism and the abnormal process that lead to the disease (Perceived susceptibility; Perceived severity; Cues to action);
• Discuss the consequences, various complications, and cost of the disease and the fact that these consequences can be prevented or delayed with proper treatment and management (Perceived susceptibility; Perceived severity; Cues to action);
• Introduce the treatments of diabetes; highlight the importance and core aspects of lifestyle modification (Perceived benefits of taking action; Cues to action; Verbal persuasion).
Topic 2: Proper physical activities • Address the importance of regular physical activity for diabetic control (Cues to action; Verbal persuasion);
• Identify common misconceptions regarding physical activity (Perceived barriers to taking action; Cues to action);
• Let the participants know the core principles of doing exercise, for example, necessary warming-up and cooling-down, sufficient duration and intensity (Cues to action);
• Introduce the benefits and advantages of ba duan jin, instruct them to practice ba duan jin step-by-step based on the video and printed materials published by the General Administration of Sport of China, and arrange reinforcement sessions to provide correction and/or further instructions following the educational sessions in week 2–4 (reinforcement sessions lasted for around 15 minutes) (Cues to action; Performance accomplishments);
• Encourage the participants to practice ba duan jin for at least 150 minutes and at least 5 days each week (Cues to action; Verbal persuasion).
Topic 3: Healthy dietary behaviors • Address the importance of healthy eating behaviors (Cues to action; Verbal persuasion);
• Identify common misconceptions regarding dietary behaviors (Perceived barriers to taking action);
• Teach the participants about the principles of healthy eating (Cues to action; Verbal persuasion);
• Let the participants know the importance of dietary constraints including sugar and salt intake; Teach them to identify and avoid foods that are sugar-rich, salt-rich or oil-rich. Use assistive tools to help demonstrate the messages; For example, when suggesting the participants take less than 6 g salt per day, use weight spoons or beer bottle caps to help the participants to have a better concept of how much salt weights 6 g (Cues to action; Verbal persuasion);
• Give individualized food recommendations based on the participants’ Traditional Chinese Medicine syndromes (Cues to action; Verbal persuasion).
Topic 4: Regular monitoring and diabetes complications surveillance • Address the importance of regular self-monitoring of blood glucose (Cues to action; Verbal persuasion);
• Identify barriers to do regular self-monitoring (Perceived barriers to taking action);
• Teach the participants skills in conducting self-monitoring of blood glucose through various methods, for example, demonstration and back-demonstration, and how to interpret the results (Cues to action; Performance accomplishments);
• Propose regular checks of other related health indicators, including HbA1c, blood pressure, lipids, and body weight (such of regular follow-up plan is rarely addressed by the healthcare professionals in Mainland China) (Cues to action; Verbal persuasion);
• Introduce the common diabetes complications and their manifestations, such as hypertension, foot ulcers and diabetic ketoacidosis; address the importance of diabetes complications surveillance and early treatments once diabetes complications are detected (Cues to action; Verbal persuasion).
Topic 5: Taking medication • Address the importance of adhering to continuous medication therapy and medication adherence (Cues to action; Verbal persuasion);
• Introduce the commonly used oral medicines and insulins, let the participants know the potential adverse drug effects of medicines, for example, hypoglycemia (Cues to action);
• Teach the participants how to store, prepare and inject insulin by demonstration and back-demonstration; Remind the participants to seek for professional help when their blood glucose control is suboptimal or the presence of adverse drug effects (Perceived barriers to taking action; Cues to action; Performance accomplishments; Verbal persuasion).
Topic 6: Risk factors management • Discuss the potential risk factors individuals with diabetes may encounter, such as smoking, alcohol abuse, and excessive exercise (Perceived barriers to taking action);
• Discuss the strategies to avoid the risk factors and the strategies to address the risk factors one presented (Cues to action; Verbal persuasion).
Topic 7: Problem solving • Discuss the common problems individuals with diabetes may encounter, for example, managing diabetes during a business trip or during a journey (Perceived barriers to taking action);
• Discuss the possible solutions to address the common problems (Cues to action; Verbal persuasion);
• Introduce the available formal or informal institutions where participants can seek for help or social supports, such as the community health service centers and the support groups organized by the diabetic peers (Cues to action).
Topic 8: Healthy coping • Address the importance of a healthy attitude toward living with diabetes (Cues to action; Verbal persuasion);
• Discuss the common psychological problems that may happen to individuals with diabetes (Perceived barriers to taking action);
• Introduce various strategies to avoid the situations that trigger these psychological problems or relieve them once presented (Cues to action; Emotional arousal);
• Remind the participants to seek for professional help once the problems are serious or last for a long time (Cues to action; Verbal persuasion);
• Introduce the real-life examples and invite peers to show the participants how their counterparts gained success over the management of the conditions (Vicarious experience);
• Encourage participants that they can also gain good diabetic control through proper self-management behaviors and that even the most difficult problems can be resolved or managed through persistent endeavors (Verbal persuasion).