Use of learning style to enhance adherence in persons with non-insulin-dependent diabetes mellitus during treatment and short-term follow-up

A 16 week pilot study was conducted to determine the effect of learning style and education program on dietary adherence in individuals with non-insulin-dependent diabetes mellitus (NIDDM). Thirty-one individuals with NIDDM from Eisenhower Army Medical Center were assessed for learning style, using a diabetes specific locus of control scale (DLC) and a participation/prescription preference rating instrument. Based on scores, subjects were assigned to a prescriptive or participatory education program with high or low reinforcement follow-up.

Two nutrition education programs were conducted on consecutive weeks for each education program. All individuals returned to the clinic for follow-up on weeks 3, 6, and 16. Subjects in high reinforcement programs were seen on weeks 10 and 14 and received post card and phone call follow-up on weeks 4, 5, 8, and 12.

At the first class (baseline) subjects were weighed and completed a knowledge test. On weeks 3 and 16 subjects were weighed, completed a self-report of adherence, and had blood drawn for a fasting blood-glucose (FOB) and a glycosylated hemoglobin (GHb). Analysis of variance and multivariate analysis were used to determine the effect of learning style and education program on weight loss, FBG, GHb and self-report of adherence.

Of four different learning styles identified, 58 percent of the sample preferred a prescriptive education approach and had a high internal DLC; 26 percent represented a prescriptive preference with both internal and powerful other DLC. Sixteen percent had participatory preference with an internal or Internal/powerful other DLC.

Individuals with prescriptive/internal orientation had greatest weight loss, largest decline in FGB, and lowest GHb levels. All learner types had significant (p ≤ .05) levels of adherence in the participatory/ high reinforcement program. Previous diabetes education was significantly related to final GHb levels versus those newly diagnosed. A significant difference was found (MANOVA p = .0067) in overall compliance between individuals with different medication levels. In conclusion, the participatory/high reinforcement group was the most effective education program for enhancing adherence regardless of learning style.