The Effects of Self-Efficacy and Physical Activity Improving Methods on the Quality of Life in Patients with Diabetes: A Systematic Review

Table 3

Characteristics of studies using health promotion programs.

Author, reference	Study design/subjects	Intervention	Instruments/measurements	Outcomes/finding	Quality rating
Clark et al. [29]	Randomized controlled trial; adults with type 2 diabetes ()	Three-month lifestyle (diet and PA) self-management program (brief tailored) plus follow-up phone calls for one year	Diabetes self-management, self-efficacy for physical activity, and barriers to diabetes self-care were evaluated at baseline, postintervention, and after follow-up	↑ PA and ↓ dietary fat in the intervention group	Moderate
Toobert et al. [25]	Randomized controlled trial; postmenopausal type 2 diabetic women ()	Mediterranean lifestyle program (6-month intervention to construct group coach and 12- and 24-month follow-up); videotapes also used for home-based practice (one hour per day)	Lifestyle behaviors (i.e., physical activity and stress management) and psychosocial variables (e.g., social support, problem solving, self-efficacy, depression, and quality of life), at baseline and 6, 12, and 24 months	↑ Quality of life (stress management, healthy diet, exercise), psychosocial factors (self-efficacy, problem solving, supportive resources), after 12 and 24 months of problem-solving	Moderate
Baghianimoghadam et al. [26]	Randomized controlled trial; diabetic patients ()	Education programs on exercise-related behavioral changes based on the health belief model (2 sessions+ reminders in 3 months)	Questionnaire based on the health belief model, a checklist related to patients practice (before and three months after intervention)	Conducting patient walking training method → ↑ self-efficacy and knowledge about the disease management	Weak
Mladenovic et al. [27]	Qualitative substudy; type 2 diabetic patients () completed healthy eating and active living for diabetes in primary care networks (HEALD) program	HEALD (primary care-based walking for 24 weeks) program	Semistructured interviews with purposefully selected HEALD completers six months after the program ended	↑ Exercise-related motivation and self-efficacy behaviors and postprogram contact with patients could improve those outcomes	Weak
Olson and McAuley [30]	Randomized controlled trial; older adults with type 2 diabetes titrated physical activity	Eight-week intervention included walking exercise and theory-based group workshops	Self-efficacy, self-regulation, and physical activity were assessed at baseline, postintervention, and a follow-up (6 months)	↑ Self-regulation/self-efficacy and physical activity at a two-month evaluation; ↓ beneficial effects at follow-up	Strong
Alharbi et al. [31]	Quasiexperiment secondary analysis of data collected from RCT; overweight adult () with heart disease and diabetes	Healthy eating and exercise lifestyle program (group-based supervised structured exercise sessions, 4 months) plus telephone follow-up calls (4 months)	Exercise, self-efficacy for weight loss, and depressive symptoms were measured at baseline, postactive phase (4 months), and postmaintenance phase (12 months)	↑ Exercise adherence and weight loss; male gender, self-efficacy, time, and depressive symptoms are independent predictors for exercise duration	Moderate
Alharbi et al. [32]	Quasiexperiment secondary analysis of data collected from RCT; patients with coronary heart disease and/or diabetes mellitus ()	One year healthy eating and exercise lifestyle program	Self-efficacy for exercise survey at baseline, at 4 months, and at 12 months	Negative association between lack of motivation and exercise self-efficacy	Moderate
Anderson et al. [33]	Quasiexperiment; dyadic data from 117 married couples in which one partner was diagnosed with type 2 diabetes	—	Survey of two exercise items (diabetes self-care activities); seven-item self-efficacy subscale of the multidimensional diabetes questionnaire	Health stress of patients in the form of higher comorbidities number and specific stress of diabetes in both patient and spouse ↔ ↓ patient adherence to exercise ↔ diabetes self-efficacy and depressive symptoms	Moderate
Thoolen et al. [28]	Randomized clinical trial; type 2 diabetic (intervention, or control, )	Self-management program (based on proactive coping and self-regulation theory in a five-step plan) lasted 12 weeks	Proactive coping, goal achievement, and self-efficacy were evaluated at baseline and postintervention	↑ PA and diet behavior, weight loss, coping, goal achievement, and self-efficacy	Moderate
Naik et al. [51]	Randomized pilot clinical trial; type 2 diabetic patients ()	Four sessions of clinician-led, patient-centered group education targeting type 2 diabetes self-management (medications, exercise, diet, home monitoring, etc.) for 3 months	HbA1c, self-efficacy scale, and specific knowledge and understanding scale at baseline, postintervention, and at the 1-year follow-up	↑ Glycemic control, self-management, and effect of time-by-treatment interaction might partially be mediated via the development of self-efficacy	Strong
Rosal et al. [34]	Randomized clinical trial; low-income Latin diabetic patients ()	Group-based intervention (12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors)	HbA1c, diet, physical activity, blood glucose self-monitoring, diabetes knowledge, and self-efficacy at baseline and at 4- and 12-month follow-up	↑ Self-efficacy and PA management at 4 months → ↓ HbA1C; ↓ statistical differences at 12 months, but ↑ patients’ knowledge about diabetes	Moderate
Sperl-Hillen et al. [35]	Randomized clinical trial; adults with type 2 diabetes ()	Individualized education (IE, 3 sessions of 1-hour individual education once a month), or group education (GE, sessions of 2-hour group education) or control (UC) for 1 year plus 6.8 months and 12.8 months	HbA1c, general health status, problem areas in diabetes, diabetes self-efficacy, recommended food score, and physical activity evaluated at baseline, 3.8 months, and 6.8 months after randomization	↓ HbA1c in all groups; ↑ exercise score, self-efficacy, and HbA1c level of individual training group compared to group education and control group	Strong
Sperl-Hillen et al. [36]	Substudy of RCT; adults with type 2 diabetes ()	Sperl-Hillen et al., 2011 study intervention	Follow up evaluation of Sperl-Hillen et al. (2011) study at 12.8 months	Behavioral and psychological improvement in IE compared to GE and UC groups; however, no sustained improvement in HbA1c, nutrition, and PA scores	Strong
Tan et al. [37]	Randomized clinical trial; Malaysian diabetic patients ()	Face-to-face education program targeting self-efficacy on self-care skills for 12 weeks	HbA1c and revised diabetes self-care activities questionnaires (monthly and postintervention follow-up)	↑ Glycemic control, diet, medication adherence, and PA	Moderate
Van Dyck et al. [38]	Randomized clinical trial; adults with type 2 diabetes ()	Social-cognitive-based method (face-to-face education, telephone follow-ups) for 24 weeks	PA (pedometer, accelerometer, and the IPAQ) and change in psychosocial factors were measured at postintervention and 1-year follow-up	↑ Patients’ self-efficacy and ↑ PA	Moderate
Jelsma et al. [39]	Randomized controlled study; women with gestational diabetes mellitus ()	Lifestyle-counselling sessions for 6 months (two face-to-face +5 telephone +5 text messages+4 mailed postcards)	Psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire (at baseline and six months)	↑ Patients’ self-efficacy and reduced barriers to active lifestyle such as lack of motivation and energy	Weak
van der Wulp et al. [41]	Randomized controlled trail; adults with recently diagnosed type 2 diabetes ()	Self-management coaching program (peer-led) on lifestyle changes (3 home visits targeting practical goals)	Self-efficacy, coping, physical activity, dietary habits, psychological well-being, depressive symptoms questionnaires at baseline and 3- and 6-month postintervention	↑ Scores of people with lower self-efficacy and psychological well-being index	Weak
Steed et al. [42]	Randomized controlled trail; patient with type 2 diabetes ()	Five weekly sessions of social cognitive (self-efficacy) and self-regulatory (illness beliefs) theory-based program	Revised summary of self-care diabetes activities (at baseline, one week, three months, and nine months)	↑ Self-efficacy for exercise immediately and three-month postintervention; essential role illness beliefs in the patients’ quality of life, and self-efficacy in self-management behaviors	Weak
Campbell et al. [43]	Randomized controlled trial; adults with type 2 diabetes ()	Three-week intervention program (diabetes factsheets and a DVD comprising patient stories (narratives) of type 2 diabetes management with follow-up at 4 weeks and 6 months)	Diabetes management self-efficacy scale (A/E DMSES) and self-care activities (SDSCA) at baseline and 4 weeks	↑ Self-efficacy behaviors	Moderate
Gamboa et al. [44, 45]	Randomized controlled trial; adults with type 2 diabetes mellitus ()	Spanish Diabetes Self-Management Program (SDSMP)	HbA1c; Spanish diabetes self-efficacy scale at baseline and 6, 12, and 24 months after SDSMP	↑ Self-efficacy and self-management for controlling the disease; exercise self-efficacy changes were not significant	Moderate
Cioffi et al. [47]	Randomized controlled trial; overweight Asian Indian adults with prediabetes ()	Four-month diabetes prevention program on self-efficacy	Exercise-related self-efficacy was measured at baseline, core intervention completion (4 months), and annually until the end of follow-up (3 years or diabetes diagnosis)	↑ Self-efficacy at treatment completion, but this effect was not sustained over longer follow-up	Moderate
Moungngern et al. [46]	Randomized controlled trial; prediabetes subjects ()	Six-month group activities of health promotion protocol (Health Belief Model, the Self-Efficacy Theory)	Diet and exercise behavior questionnaire, the self-efficacy questionnaire	↑ Awareness, ↑ self-efficacy, and a realization of the benefits of health behavior modification	Moderate
King et al. [48]	Quasiexperiment on baseline data; diabetic patients () with elevated BMI	—	Physical activity, adherence to diabetes, self-efficacy, and social-environmental variables were measured with different questionnaire and scale	↑ Psychosocial and social-environmental factors→ ↑ diabetes self-management; but independent association between self-efficacy factors with exercise	Weak
Dyck et al. [49]	Quasiexperiment; type 1 diabetes (T1D, ) and diabetes care providers (DCP, )	Four weekly group sessions to learn about exercise physiology and experience different exercise types	Diabetes distress screening scale; physical activity and exercise; Counselling survey in DCP	Intervention did not improve exercise self-efficacy of TID but improves DCP self-efficacy in providing exercise advice to patients	Weak
Powell et al. [50]	Quasiexperiment; diabetic patient counselor/educators ()	—	Evaluation of delivering diabetes self-management/support in diabetes educators	Challenging barriers were lack of enough time for delivering patient visits and inability to encourage patients for physical activity	Weak
Miller et al. [40]	Randomized controlled trial; prediabetic university employees ()	Sixteen-week group-based diabetes prevention program +3-month follow-up	Self-efficacy, behavioral self-regulation, and goal setting determinants were assessed at baseline, postintervention, and 3-month follow-up	Improvement in behavioral outcomes such as physical activity and diet self-efficacy and goal commitment in the intervention group	Strong