Tang Yan, Soh Kim Lam, Gan Wan Ying, Zhou Junjun, Soh Kim Geok
Department of Nursing, University Putra Malaysia, Selangor, Serdang, Malaysia.
Faculty of Nursing, Jiangsu Medical College, Yancheng, Jiangsu, China.
BMC Public Health. 2025 May 29;25(1):1980. doi: 10.1186/s12889-025-23073-9.
Type 2 diabetes is a global public health challenge characterized by high prevalence and poor self-management outcomes. The PRECEDE-PROCEED model is a well-known conceptual widely used to promote health in chronic diseases. This meta-analysis evaluated the efficacy of interventions based on PRECEDE-PROCEED model in reducing Glycated Hemoglobin A1c (HbA1c) and enhancing self-management in patients with type 2 diabetes.
Nine online databases-PubMed, Cochrane Library, Embase, PsycINFO, Scopus, CINAHL, Web of Science, CNKI, and WANFANG-were searched from inception to June 2024. Randomized controlled trials (RCTs) and quasi-experimental studies (QESs) were identified using keywords related to the PRECEDE-PROCEED model, type 2 diabetes, and self-management. Review Manager 5.4 was used for meta-analysis and the 95% confidence intervals (CIs) was calculated for standardized mean differences (SMDs) or weighted mean differences (WMDs).
Fourteen studies (11 RCTs and 3 QESs) involving 2,478 patients met the eligibility criteria. Interventions significantly reduced HbA1c, with progressive improvements over time: WMD = -0.41 (95% CI: -0.58 to -0.24) at 1 month, -0.50 (95% CI: -0.67 to -0.33) at 3 months, and -0.63 (95% CI: -0.93 to -0.33) at 6 months. Significant improvements were also observed in total self-management scores (SMD = 2.53; 95% CI: 1.14to 3.91) and in key PRECEDE-PROCEED model variables, including knowledge, attitudes, self-efficacy, reinforcing, and enabling factors, though high heterogeneity was noted.
The PRECEDE-PROCEED model is an effective framework for reducing HbA1c and enhancing self-management among patients with type 2 diabetes. Future research should focus on standardizing intervention protocols and developing unified outcome measures to improve reproducibility and cross-study comparability.
The PROSPERO registration ID is CRD42024600814.
2型糖尿病是一项全球性的公共卫生挑战，其特点是患病率高且自我管理效果不佳。PRECEDE-PROCEED模型是一个广为人知的概念框架，广泛用于促进慢性病的健康管理。本荟萃分析评估了基于PRECEDE-PROCEED模型的干预措施在降低2型糖尿病患者糖化血红蛋白A1c（HbA1c）水平及增强自我管理能力方面的疗效。
检索了9个在线数据库——PubMed、Cochrane图书馆、Embase、PsycINFO、Scopus、CINAHL、Web of Science、中国知网和万方——从建库至2024年6月。使用与PRECEDE-PROCEED模型、2型糖尿病和自我管理相关的关键词识别随机对照试验（RCT）和准实验研究（QES）。使用Review Manager 5.4进行荟萃分析，并计算标准化均数差（SMD）或加权均数差（WMD）的95%置信区间（CI）。
14项研究（11项RCT和3项QES）涉及2478例患者，符合纳入标准。干预措施显著降低了HbA1c水平，且随着时间推移有逐步改善：1个月时WMD = -0.41（95%CI：-0.58至-0.24），3个月时为-0.50（95%CI：-0.67至-0.33），6个月时为-0.63（95%CI：-0.93至-0.33）。在总自我管理评分（SMD = 2.53；95%CI：1.14至3.91）以及PRECEDE-PROCEED模型的关键变量（包括知识、态度、自我效能、强化因素和促成因素）方面也观察到显著改善，不过存在高度异质性。
PRECEDE-PROCEED模型是降低2型糖尿病患者HbA1c水平及增强自我管理能力的有效框架。未来研究应聚焦于规范干预方案并制定统一的结局指标，以提高可重复性和跨研究可比性。
PROSPERO注册号为CRD42024600814。
