Background: Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors, such as the type of programmes provided and patients' level of health literacy…

Research has documented the use of tools in computer-based learning environments as problematic, that is, learners do not use the tools and when they do, they tend to do it suboptimally. This study attempts to disentangle cause and effect of this suboptimal tool use for experienced learners. More specifically, learner variables (metacognitive and…