The Effectiveness of an Occupation-Based Lifestyle Program in Individuals With Type 2 Diabetes

Background and Rationale:

Type 2 diabetes mellitus accounts for 90-95% of diabetes cases worldwide and presents significant challenges in physical and psychosocial functioning. Effective management requires long-term lifestyle adaptations, including healthy eating, physical activity, blood glucose monitoring, medication adherence, problem-solving, and stress management. While traditional lifestyle interventions improve clinical indicators in the short term, their long-term behavioral sustainability can be limited. Occupation-focused occupational therapy interventions integrate diabetes self-management into daily habits and meaningful roles, offering a structured framework to improve quality of life and health outcomes.

Study Design and Population:

This study is a quasi-experimental controlled trial conducted online. The target population consists of individuals aged 18-74 who have been diagnosed with Type 2 diabetes for more than 12 months, have internet access for online sessions, and provide documented proof of their diagnosis. Sample size calculation using G*Power (alpha = 0.05, power = 0.80, effect size d = 0.8) determined a required total sample size of 42 participants (21 per group).

Intervention:

Participants in the intervention group will participate in an 8-session (60 minutes per session, twice weekly) online program via Zoom, structured into 5 modules:

Module 1: Awareness (Session 1): Education on diabetes management, identifying daily challenges, and establishing individual occupational priorities using the Canadian Occupational Performance Measure (COPM).

Module 2: Problem Solving (Sessions 2 \& 3): Teaching structured problem-solving steps tailored to diabetes self-management and personal goals.

Module 3: Stress Management (Sessions 4 \& 5): Training in mindfulness techniques (breath awareness, body scan, sensory awareness) and integrating them into daily routines.

Module 4: Energy Conservation and Physical Activity (Sessions 6 \& 7): Instruction on activity-role balance, energy conservation principles, and embedding safe physical activities (walking, home exercises) into daily life.

Module 5: Goal Review and Sustainability (Session 8): Re-evaluating COPM goals, addressing barriers, and developing sustainable long-term strategies.

Participants in the control group will receive an informative educational brochure (covering diabetes awareness, problem-solving, physical activity, mindfulness, and energy conservation) upon completion of the intervention group's program.

Outcome Measures:

Data will be collected via Google Forms at baseline (pre-test) and post-intervention (post-test) using the following instruments:

Demographic and Health Information Form

Canadian Occupational Performance Measure (COPM): Evaluates occupational performance and satisfaction.

Diabetes Self-Management Questionnaire (DSMQ / DÖYS): Assesses self-care activities associated with glycemic control.

Occupational Balance Questionnaire (OBQ11-T / ARDA11-T): Measures satisfaction with the balance of daily activities and roles.

Diabetes Symptom Checklist (DSC / DBKLÖ): Evaluates the presence and burden of physical and psychological diabetes symptoms.

Short Form-36 Health Survey (SF-36): Measures health-related quality of life across 8 domains.

Program Satisfaction Survey: Evaluates intervention group feedback on program content, applicability, and online delivery.

Statistical Analysis:

Data analysis will be performed using SPSS (Version 26.0). Descriptive statistics will summarize participant characteristics. Within-group pre-post changes and between-group differences will be analyzed using parametric tests (paired t-test, independent samples t-test) or non-parametric tests (Wilcoxon signed-rank test, Mann-Whitney U test) depending on normality distributions, with significance set at p \< 0.05.