Health Extension for Diabetes: Development, Implementation, and Effectiveness of a Community-Based Diabetes Self-Management Support Program

Abstract

Objectives: Health Extension for Diabetes (HED) is a community-based diabetes self-management support program facilitated by trained rural health and nutrition agents who lead 8 biweekly educational sessions supported by a diabetes clinical expert. We evaluated the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods: Since the HED program’s conception in 2017, ongoing longitudinal evaluation has measured participant knowledge, self-efficacy, and other health behaviors via pre- and postsurveys (at program completion, at 1 year, and at 2 years). We used paired-sample t tests to assess significant changes in effectiveness outcomes from pre- to postintervention. Results: Of 1526 participants enrolled in the HED program from 2018 to 2024, 1434 (94.0%) graduated. Mean physical health–related quality-of-life scores rose from 42.8 to 45.1, and mental health scores increased from 51.4 to 52.9 (on a 100-point scale). We assessed weekly diabetes self-care activities and found improvements in general diet (from 4.1 to 5.0 days/week), specific diet (from 3.9 to 4.7 days/week), exercise (from 2.6 to 3.7 days/week), blood glucose testing (from 4.2 to 5.2 days/week), and foot care (from 3.4 to 4.6 days/week). Average diabetes knowledge increased from 76.4% to 85.0%, and self-efficacy increased from 7.1 to 8.2 on a 10-point scale. Participants had reductions in weight (−3.4 pounds), body mass index (from 34.3 kg/m2 to 33.7 kg/m2), and self-reported hemoglobin A1c (from 7.5% to 7.0%). All pre- to postsurvey changes were significant at α = .05. Conclusions: The HED program offers a scalable and sustainable approach to community-based diabetes self-management support. Program expansion and replication should leverage key implementation strategies identified via this RE-AIM framework evaluation.