4.1. The intervention based on the BASNEF model
The present study indicates that a BASNEF-based intervention may improve patient lifestyle by increasing knowledge, changing patient beliefs and attitudes in a healthy way, and altering social norms using the engagement of family of patients. In line with our study, Villarino et al.[15] Baghiani moghadam et al.[16] and Arani et al.[17] indicates that the lifestyle intervention program based on the BASNEF model has significant privileges regarding meaningful commitment to treatment in patients with hypertension. In a study conducted by Khani Jeihooni et al.[9] knowledge, attitude and subjective norms of participants increased three months after intervention.
4.1.1. Knowledge
Present findings reported that knowledge was significantly improved after interventions in all intervention groups compared to control group except for two-month follow-up. Askari et al.[18] study showed that the mean score of awareness of subjects in the experimental group increased meaningfully. Other studies in line with the present showed that educational intervention improved patients’ knowledge.[9, 19, 20] According to the numerous studies, the effectiveness of educational interventions to improve awareness might be likely beneficial in disease control.
4.1.2. Attitude
Attitude toward a behavior means people's willingness to perform desired behavior, and it is accordance with the judgment of a person about the consequences of that behavior on his/her life.[9] At present, attitude of participants improved in post intervention in all groups of the study except for two-month follow-up. In Afshary et al.[21] study, educational intervention resulted in improvement of attitude toward diabetes. In addition, Zhong et al.[22] and Khattab et al.[23] cited positive attitude of patients about treatment.
4.1.3. Subjective norms
Subjective norms are known as effective social pressures for doing or not doing a behavior. Due to increasing social pressures and supports from family members, health care providers, and friends for doing healthy behaviors, patient’s sentiment for conducting healthy behaviors increases.[24] We found that all intervention groups influenced the subjective norms compared to the control group. Rothschild et al.[25] revealed that more participation of health center providers results in the improvement of glycemic control in patients with diabetes. Relationship with health center officials has a great effect on health promotion of patients suffering from chronic diseases. In a study conducted by Movahed et al.[26] general physicians, families, and friends were the most vital guides of patients for implementing self‑medication behaviors.
4.1.4. Enabling factors
A condition in which a person wants to perform a behavior but cannot do it due to some deficiencies such as time, money, resources, skills, and accessible health care that are named enabling factors.[18] Given the present results, enabling factors improved significantly after intervention. In Askari et al.[18] study to control diabetes, the factors such as providing information through training sessions and booklets supported elderly patients with type II diabetes. The current findings are relevance with those of Khani Jeihooni et al.[9] Zendehtalab et al.[27]
The BASNEF model identifies numerous factors, including understanding, attitudes, cultural merits, and social influences. According to this model, families, friends, and other important individuals, can affect the perception of psychological and social well-being of people.[15] At present, lifestyle interventions to control or change nutritional behavior must involve the patients and health care providers, family, and also the other essential people with significant effects on the behavior of individuals.
4.2. Comparison of the mean scores of BAZNEF model constructs between investigation groups
At present, mean scores of BAZNEF model increased in all intervention groups in all three follow-ups, while no changes were seen in the control group.
4.2.1. The Collaborative Care Model findings
Our findings also presented the beneficial effect of CCM for patients with type 2 diabetes. The important issue in diabetic patients is the continuation of treatment and regular use of drugs, which was still present after 12 months. For further description, the mean score of all constructs of the model (knowledge, attitude, subjective norms and enabling factors) were improved remarkably in all three follow-ups. The useful impact of CCM on improving health outcomes and reducing medical errors is well-documented.[28, 29] CCM resulted in an increase in patient’s quality of life and improvement of patient health status.[30]
4.2.2. The Motivational Interviewing Technique
According to the present, MI results were meaningfully improved in all three follow-ups for all constructs of the model, as well. MI has become an intervention applied for physical health, to encourage behavior change among people diagnosed with chronic conditions. For instance, it has been used in efforts to improve outcomes correlated with the management of type II diabetes and obesity.[8] In a systematic review implemented by Macnamara et al.[31] the positive impacts of the MI technique were widely introduced in aspects of oral health. In addition, systematic reviews have cited the lucrative effects of MI in terms of overweight and obesity, [32] and other metabolic risks, and blood pressure.[8]
4.2.3. The Family Centered Empowerment Model
Family support makes patients motivated to do self-care behaviors in terms of diabetes. FCEM was developed to enhance the care and subsequence of patients with chronic conditions. [33] According to present findings, FCEM results were meaningfully refined in two, six and twelve follow-ups for all constructs of the model. In a study conducted by Shahabi et al.[5] FCEM resulted in a notable increase in compliance with a diet regimen and its aspects among patients with type 2 diabetes. Agarwal et al.[34] showed that in the lack of family support, adherence to treatment regimen decreases after discharge from the hospital.