Purpose: To evaluate the efficacy of a PRECEDE model-based educational program in enhancing awareness, attitudes and preventive behaviors against diabetes complications among rural patients with type 2 diabetes mellitus (T2DM). Design/methodology/approach: This quasi-experimental study included 160 T2DM patients from rural health centers in Andimeshk, Iran (2020-2021). Participants were randomly assigned to intervention (n = 80) or control (n = 80) groups. The intervention group received a six-session in-person educational program, supplemented by weekly lifestyle videos via WhatsApp over six weeks, guided by PRECEDE model constructs. A validated questionnaire assessed knowledge, attitudes, enabling and reinforcing factors, and preventive behaviors pre- and post-intervention. Findings: Post-intervention, the intervention group demonstrated significantly (p < 0.001) higher mean scores in knowledge, attitudes, enabling factors, reinforcing factors and preventive behaviors than controls. Fasting blood sugar (FBS) levels were significantly (p < 0.001) reduced in the intervention group at three-month follow-up. Originality/value: The findings demonstrate that a comprehensive program grounded in the PRECEDE model can significantly enhance patients' awareness, strengthen positive attitudes, increase enabling and reinforcing factors and promote preventive lifestyle behaviors. Importantly, the intervention led to improved glycemic control, as evidenced by reduced fasting blood sugar levels at three-month follow-up. These results suggest that tailored, theory-driven educational initiatives have the potential to empower rural patients with type 2 diabetes to make sustainable lifestyle changes and better manage their condition. The study provides a model for developing and implementing effective diabetes self-management programs in underserved rural communities, which can ultimately contribute to reducing diabetes-related complications and improving overall health outcomes in this population.