Development of Practice Guideline for Enhancing Stage-Based Behavioral Modification of Pre-Diabetic Persons

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Naiyana Chana
Natee Geurgoolgitjagan
Sang-arun Isaramalai


This developmental research aimed to develop a practice guideline for enhancing stage-based behavioral modification for pre-diabetic persons. Based on the transtheoretical model and IOWA model of evidence-based practice, two phases, development and evaluation, were conducted. The content validity of the guideline was examined by three experts and its pre-testing was conducted by five healthcare providers in a primary care unit. The practice guideline consisted of 2 steps: 1) assessment of changing behavioral stage and 2) implementation of behavioral modification activities on dietary control and exercise for the persons with pre-diabetes based on their changing behavioral stage. The activities in the precontemplation stage were designed for consciousness raising and dramatic relief. The activities in the contemplation stage were for self re-evaluation and social liberation. The activities in the preparation stage were on self-liberation. Lastly, the activities in the stage of action and behavioral maintenance were for reinforcement through group process. The content validity of the guideline was approved by all experts. The results of pre-testing confirmed that the guideline was practical. Only the activities for dramatic relief on dietary control and making dietary records were reported to be difficult and needing advanced practice. As a result, an assessment form was additionally developed for use as a tool in the precontemplation stage.

The guideline can be implemented effectively by providing a training course for all primary care providers on behavioral modification for dietary control and exercise. This should facilitate pre-diabetic persons maintain and sustain their dietary control and exercise behaviors.


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Chana, N., Geurgoolgitjagan, N., & Isaramalai, S.- arun. (2014). Development of Practice Guideline for Enhancing Stage-Based Behavioral Modification of Pre-Diabetic Persons. Journal of Research in Nursing-Midwifery and Health Sciences, 34(1), 25–40. Retrieved from
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