Effect of academic education on promoting a healthy lifestyle in pre-diabetic women: RCTs | BMC Women’s Health
The present study showed that the health education program based on the theory of planned behavior is effective in encouraging pre-diabetic women to promote a healthy lifestyle and improve their fasting blood sugar levels.
In this study, sample dropouts during the study because in the process of creating health behaviors in order to change women’s attitudes and create stability and sustainability in health behaviors (diet and activity physical), an intervention with sufficient time in the educational sessions is necessary, consequently the dropouts of samples during the study. However, to improve some educational content can be delivered indirectly through educational booklets, leaflets, or via social networks to reduce the number of training sessions.
In this study, baseline assessment results showed that pre-diabetic women’s healthy lifestyle information was 0.059 out of 1 score. After three face-to-face training sessions, the knowledge of pre-diabetic women in the experimental group increased significantly (0.73 on 1 score) compared to before the intervention and to the control group, which is consistent with the results of the study. study of whites . During the sessions, people were informed about behaviors that reduce the risk of diabetes, and given the role of women in food preparation and cooking, improved knowledge can significantly affect the quality of the food for their family. After the educational intervention, the attitude related to physical activity in the intervention group increased significantly, which was consistent with the results of the Sanaeinasab study. White  who had studied physical activity using the theory of planned behavior. However, in the present study, in line with White’s study , there was no significant increase in the attitude of the intervention group regarding healthy eating. However, the attitude of the control group in this regard increased significantly. Completing a questionnaire in this group may affect their belief in the importance of eating healthy foods and improve their attitude.
After the intervention, no significant change was found in the subjective norm of the experimental group with respect to physical activity and healthy eating, which contradicts Maleki’s study . Also in Taghipour’s study , holding training sessions on physical activity for family and friends of the volunteers, led to the promotion of subjective norms related to physical activity in the intervention group. In the present study, the intervention group was asked to provide an educational booklet to their family members, which we believe would affect their subjective norms. Therefore, it can be concluded that this method of intervention fails to improve the subjective norms of the participants and other methods should be used to improve the subjective norms.
After the educational intervention, the average perceived behavioral control score in the experimental group increased, indicating an increase in the individuals’ ability to resist barriers to physical activity and is consistent with Sanaeinasab results. .
Literature on people with prediabetes shows that those who participate in self-management and self-efficacy training progress along the continuum necessary to effect and sustain behavior change. [19,20,21].
In the present study, the presentation of an educational program on factors facilitating behaviors, providing incentives, reducing and eliminating perceived barriers, and using participants’ experiences increased the perceived behavioral control of women in the intervention group. However, no significant changes were found in perceived behavioral control over healthy eating in the intervention group. Therefore, it can be concluded that improving healthy eating requires a longer educational session or other methods should be used to improve perceived behavioral control over healthy eating.
The results show that there was no statistically significant difference between before and after the intervention in terms of diet in the intervention group, because almost the TPB construct (attitude, perceived behavior control, intention and knowledge ) increased after the intervention.
In the educational intervention, in addition to expressing the benefits of exercise and the harms of inactivity, strategies for adopting sports behaviors and a list of physical activities that can easily be practiced daily were presented and participants were encouraged to select activities that they could do regularly. . However, no significant change was found in the behavioral intention of the intervention group and the mean physical activity performance of both groups decreased (although not statistically significant), which was consistent. with the result of the study by Williams et al.  on the physical activity of outpatients using TPB. While Sanaeinasab  showed that TPB is effective in promoting physical activity, the reason for this discrepancy could be the cold weather conditions and the global outbreak of coronavirus during the monitoring period of the present study.
According to the study by Chen et al.  that a 16-week, three-phase empowerment program including awareness, behavior development, and ABC outcomes for pre-diabetic patients significantly improved healthy lifestyles and self-efficacy, in the present study , the average eating performance among pre-diabetic women in the intervention group was also significantly higher than the control group. After the educational intervention in the experimental group, mean fasting blood glucose levels improved compared to before the intervention and the control group, which is consistent with Shamizadeh’s study  using social cognitive theory, Chen  using the ABC and Ibrahim empowerment program  through a community intervention program on healthy lifestyles.
The improvement in the fasting blood glucose of the experimental group in our study could be due to the improved eating performance in the experimental group. After the intervention, no new cases of diabetes were observed among the prediabetic patients in the intervention group.
One of the strengths of the present study is to study the unknown group of hard-to-reach prediabetics at high risk for diabetes. Moreover, these results can be used by others around the world, especially in developing countries (with a similar socio-economic status), because the theoretical training in this study can promote knowledge and a lifestyle healthy in pre-diabetic women.
Among the limitations of the present study are the collection of information by self-report, the tracking of samples, coinciding with the prevalence and critical conditions of the coronavirus, as well as the absence of predisposing cases in the electronic health record, l made it difficult to identify these people.
It is suggested that future studies be conducted with other theories and questionnaires with more specific questions on healthy lifestyle behavior and assess glycemic control with the glycosylated hemoglobin test.