Assessment of a National Diabetes Education Program diabetes prevention toolkit: The D2d experience.

There was no control group that did not receive the GAME PLAN toolkit, so changes cannot be attributed to the toolkit. Participants were also randomized to daily vitamin D or placebo, so the contribution of the booklet cannot be separated from the trial intervention. Investigators could not control for diabetes information participants received from outside sources. The time between receiving the booklet and the post-test may have been too long to assess short-term retention, and it is unknown whether participants read the materials. Pre- and post-test repeated measurement effects may have influenced scores. The analyzed sample was 360 post-test participants rather than all pre-test participants. The cohort was highly educated, which may limit generalization to less educated populations. Participants had already enrolled in a diabetes prevention study, so they may have been ready for behavior change, with a possible ceiling effect. Only a small share of Spanish materials was assessed, limiting comparison between English and Spanish audiences. The study did not follow participants long enough to assess long-term knowledge, behavior, or clinical outcomes. The questionnaires were pre-tested only in a small sample, so validity and reliability were not established.

The National Diabetes Education Program evaluated its own GAME PLAN toolkit. No author conflict-of-interest declaration is provided in the supplied text.

Do not conclude that the GAME PLAN booklet caused the score increases. Participants were also randomized to daily vitamin D or placebo, there was no control group for the booklet, and investigators could not account for diabetes information from outside sources. The booklet's contribution cannot be separated.