Effect of Interactive Video-Based Self-Management Education in Adults With Type 2 Diabetes

This doctoral thesis study is designed as a parallel-group, single-blind, randomized controlled interventional trial aimed at evaluating the effects of an interactive video-based self-management education program on glycemic control, self-management behaviors, and empowerment in individuals with type 2 diabetes. To ensure methodological transparency and adherence to established scientific reporting standards, the detailed study protocol is planned to be published as a separate scientific article.

Eligible adults with type 2 diabetes will be randomly assigned in a 1:1 ratio to either the intervention or control group. Block randomization with a fixed block size of six will be used to maintain balanced group allocation throughout the study period. The randomization sequence will be generated using a computer-based random number system by an independent individual who is not involved in participant recruitment, intervention delivery, or outcome assessment.

Prior to the main trial, a pilot study will be conducted to assess the acceptability and usability of the developed interactive video-based education program. Findings from the pilot study will be used solely to refine the intervention content and research procedures and will not be included in the sample or final analyses of the main trial. The results of the pilot study are also planned to be reported in a separate scientific publication.

Participants assigned to the intervention group will receive an interactive video-based diabetes self-management education program developed in accordance with the American Association of Diabetes Educators' AADE7 Self-Care Behaviors framework. The educational content will be structured around scenario-based representations of self-care behaviors that individuals with diabetes are expected to perform in their daily lives. The scenarios will be enacted by an individual assuming the role of a patient and will realistically reflect situations commonly encountered in everyday life. Each educational video will have an approximate duration of 5-10 minutes.

The video-based intervention will address the following AADE7 domains: Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risk, and Problem Solving. Content validity will be established through expert review, with the scenarios evaluated by 10 experts experienced in nursing and internal medicine. Revisions will be made based on expert feedback, and the appropriateness of the educational materials will be assessed using the Davis technique. The finalized scenarios will subsequently be produced as educational videos.

The videos will be converted into an interactive format by incorporating elements such as question-and-answer segments, fill-in-the-blank activities, pop-up informational screens, and highlighted content areas. When participants provide incorrect responses to interactive questions, an explanatory video segment presenting the correct answer will be displayed, with the aim of supporting active learning and enhancing knowledge retention.

Participants in the control group will continue to receive standard routine care. Baseline assessments will be conducted prior to group allocation, and outcome measures will be evaluated at baseline and follow-up to assess changes in glycemic control, diabetes self-management, empowerment, and quality of life. In addition, participants' satisfaction with the educational materials will be assessed at the 3-month follow-up using the Satisfaction Evaluation Form.

Inclusion criteria

• Aged between 18 and 65 years (Mumcu & İnkaya, 2022).
• Able to read, write, understand, and speak Turkish.
• Diagnosed with type 2 diabetes for at least one year (Onyia et al., 2023; Shahshahani et al., 2023).
• Receiving oral antidiabetic agents and/or insulin therapy (Mikhael et al., 2019).
• Having an HbA1c level >7% in at least one measurement within the last 3 months (Hu et al., 2023; Lee et al., 2020; Asmat et al., 2023; TEMD, 2024).
• Volunteering to participate in the study.
• Owning a personal device (e.g., smartphone) capable of playing interactive videos.
• Having the ability to use a smartphone capable of playing interactive videos, which will be assessed by observing the participant using an interactive video -not related to the study intervention.
• Owning a smartphone with an active internet data plan.
• Being able to attend scheduled follow-up visits at the frequency required for study measurements.
• Having a body mass index (BMI) ≥18.5 kg/m² (Lee et al., 2022).
• Not following a vegan or vegetarian diet (Dening et al., 2023).
• Having hemoglobin levels within normal ranges (women: 12-16 g/dL; men: 14-18 g/dL) (Billett, 1990).

Exclusion criteria

• Having previously received video-based diabetes education.
• Currently using or having previously used a video-based tool or program supporting type 2 diabetes management.
• Having severe visual, auditory, cognitive impairments, or physical disabilities that may interfere with participation.
• Being hospitalized as an inpatient during the intervention period.
• Being pregnant, planning pregnancy within the next 6 months, or becoming pregnant during the study.
• Breastfeeding during the study period (due to potential dietary restrictions).
• Using any weight-loss medication or supportive pharmacological agent.
• Having a diagnosis of sickle cell anemia or being diagnosed during the study period (TEMD, 2024, p.18; Eyth et al., 2025).
• Receiving hemodialysis, having experienced recent bleeding or blood transfusion, or receiving erythropoietin therapy (TEMD, 2024, p.18; Eyth et al., 2025).
• Having a diagnosed psychiatric disorder (e.g., major depressive disorder, bipolar disorder, schizophrenia).
• Participating in another diabetes-related intervention or program during the study period.
• Using an insulin pump (Lee et al., 2022).
• Managing diabetes with nutrition therapy alone without pharmacological treatment.
• Following a diet prescribed and supervised by a dietitian due to another medical condition or surgical procedure.