Role of theories in school-based diabetes care interventions: A critical review

BACKGROUND: Diabetes is one of the most common chronic diseases of childhood. School plays an essential role in the management of student diabetes, which reduces the risk of short- and long-term diabetes complications and ensures that students are well-positioned for optimal academic performance and growth. AIM: The aim of this review was to systematically identify and synthesize the literature concerning theory-based diabetes care interventions in K-12 schools in the United States. It critically assessed the specific role of theories and associated essential constructs in intervention design, implementation, outcome measurement, and evaluation. METHODS: Relevant literature was identified by keyword searches of the Cochrane Library, PubMed, and Web of Science. RESULTS: Four interventions met the eligibility criteria and were included in the review. Of those, two evaluated online diabetes education programs for school personnel and the other two assessed in-person interventions. Three studies adopted a one-group pre-post study design, and the remaining one adopted a one-shot case-study design. Three of the interventions adopted social cognitive theory, and the remaining one was guided by the diffusion of innovations theory. Three studies identified core constructs of a theory as predictors of behavioral change. Two used theory to select or develop intervention techniques. Two studies used theory to customize participant intervention techniques. Two studies discussed their findings in the context of theory. No study used theory to select potential intervention participants. CONCLUSION: In conclusion, despite the value of theory in intervention design and evaluation, theory-based diabetes interventions at school remain scarce. Future research may seek ways to better integrate theory and empirical research.