stical study and should be replicated regularly to determine how (or if) smoking behavior among the population has changed since the 1999 sample was drawn.
Whittemore (2000) conducted a study with the purpose of critically examining the literature about strategies and factors that influence lifestyle change in individuals with diabetes. Using a meta-analysis research design, articles of an empirical nature on lifestyle change published between 1985 and 1999 were reviewed. A total of 90 articles were identified and 72 met inclusion criteria. Findings indicated that positive outcomes of lifestyle changes are associated with diabetes education programs that focus on self-management, emphasize behavioral strategies, and provide culturally relevant information.
The Whittemore (2000) study concluded that theoretically grounded research in diabetes care is imperative for the future and as a means of improving nursing and other care interventions. Though informative, this meta-analysis was limited in that it employed a broad set of categories for identifying "lifestyle changes" and strategies for inducing such changes. A more narrowly defined categorization strategy would have been helpful in determining which of the specific interventions (rather than types of interventions) was most effective in inducing diabetes patients to undertake lifestyle changes to improve their health status.
Raji, Gomes, Beard, MacDonald, and Conlin (2002), noting that patient education is the cornerstone of treatment in Type 1 diabetes, also commented that there is no unanimity of opinion as to how such interventions should be delivered. The objective of their research was to determine whether a single, intensive group educational program would improve glycosylated hemoglobin (Hb[A.sub.1x]) levels when compared
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