Participants randomized to the control
arm received a bilingual newsletter called
DiabetesAction. Thirty-six mailed newsletters
covered the AADE 7 topics and the 5 general
self-management skills, providing control
participants with the same number of contacts
as received by those in the intervention arm
and comparable diabetes self-management ed-
ucation. We adopted this behavioral control
experience, rather than usual care alone, for
both ethical and scientific reasons. Because
this population receives low rates of diabetes
education, we sought to ensure that all
participants had access to some form of self-
management training. In addition, the rela-
tively intensive newsletter control sought to
reduce the risk that any differences would be
attributable to a Hawthorne effect, in which
attention, rather than the specific intervention,
produces change.