Diabetes has become a major public health problem in China with 8.2% of rural residents having diabetes
. Strategies aimed at improving diabetes care are desperately needed. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes
[2, 3]. Evidence shows that diabetes self-management education can lead to improvements in outcomes such as glycemic control at least in the short term when delivered in community settings
[3–5]. Despite this encouraging evidence, supporting self-management is the least implemented and most challenging area of chronic disease management
In 1999, the authors introduced and tested the Chronic Disease Self-Management Program (CDSMP) - a generic community-based lay-led patient self-management education course developed by Lorig et al. at Stanford University
- in Shanghai as a new approach to help people with chronic conditions
[8, 9]. On the basis of needs assessments, a series of peer-led community-based disease-specific self-management programs including diabetes have been developed, tested and widely disseminated in urban communities of Shanghai in the last ten years
[10–14]. More than 1.6 million people attended the chronic disease self-management courses in Shanghai as of the end of 2010
. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai due to inability to recruit enough volunteer lay leaders, community residents' low levels of literacy and their scattered living circumstances
. Therefore, exploring alternative strategies to support patient self-management in rural communities is desperately needed.
Self-management can be taught and supported by not only peer leaders, but also health care professionals, office support staff, and other patients
. The group visit model, developed in managed care settings to address issues of treatment effectiveness and efficiency, offers promise in improving efficiency and encouraging patient self-management
[16, 17]. The group visits typically offers patients routine primary care (examinations, diagnoses, and prescriptions) in combination with group support and self-management education
[17, 18]. Therefore, compared to the peer-led self-management support, providing self-management support in the form of group visits has a stronger linkage to the routine primary care, which may be more acceptable to rural community residents with limited access to health care services.
To date, no other study on group visits has been conducted in the Chinese population. The goal of this study was to explore the group visit model as a new approach to support diabetes patient self-management in rural communities in Shanghai. Our study aimed to develop a Chinese diabetes group visit program and to examine its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes.