Carla K. Miller

Food Selection and Eating Patterns: Themes Found among People with Type 2 Diabetes Mellitus

OBJECTIVEnThe objective of this study was to examine the beliefs and perspectives among people with type 2 diabetes mellitus about dietary requirements, food selection and eating patterns, and attitudes about self-management practices.nnnDESIGNnSemistructured, in-depth interviews explored participants experiences with diabetes prior to their diagnosis, participants understanding of the guidelines for the nutritional management of diabetes, how participants applied their understanding of dietary guidelines to daily food selection and eating patterns, and the social and personal themes influencing participants food selection and eating patterns.nnnSUBJECTSnInterviews were conducted with members of a convenience sample of 45 men and women diagnosed with type 2 diabetes for at least 1 year. ANALYSES PERFORMED: Interviews were coded using a conceptual matrix derived from participants statements. Common characteristics were grouped, and broad themes were identified.nnnRESULTSnEating patterns were influenced by participants knowledge of diabetes management. Challenges that participants encountered when applying nutrition recommendations were linked to their prior eating practices. Dietary self-efficacy, social support, and time management were identified as mediating variables that can influence dietary behaviors.nnnIMPLICATIONSnDiabetes nutrition education programs should increase awareness of eating history, spousal support, and time management practices. Future research should include the refinement and validation of a nutritional management model of diabetes.

Evaluation of a Theory-based Nutrition Intervention for Older Adults With Diabetes Mellitus

OBJECTIVEnTo evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus.nnnDESIGNnA randomized pretest-posttest control group design was used.nnnSUBJECTS/SETTINGnParticipants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting.nnnINTERVENTIONnThe intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation.nnnMAIN OUTCOME MEASURESnParticipants knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation.nnnSTATISTICAL ANALYSES PERFORMEDnFactor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups.nnnRESULTSnTwo factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean +/- standard error of the mean: 7.8+/-0.7) than the control group (0.2+/-0.7) (P < .0001), positive outcome expectations (0.59+/-0.15 vs 0.06+/-0.15, P = .01), promoters of diabetes management (0.83+/-0.12 vs -0.09+/-0.18, P < or = .001) and decision-making skills (5.1+/-0.5 vs 0.3+/-0.5, P < .0001) and greater reduction in barriers to diabetes management (1.1+/-0.16 vs 0.34+/-0.16, P < .01). No significant difference in negative outcome expectations occurred between groups at posttest.nnnAPPLICATIONS/CONCLUSIONSnOlder adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management.

Spousal Support and Food-Related Behavior Change in Middle-Aged and Older Adults Living With Type 2 Diabetes

One of the most challenging diabetes-related behavior changes is adhering to a healthful diet. Drawing on the social cognitive theory and social support literature, this qualitative study explores how spousal support influences dietary changes following a diagnosis of type 2 diabetes in middle-aged and older adults. The purpose of this study was to determine how aspects of the spousal relationship translate into behavior changes, specifically adherence to a healthful diet. Analyses revealed five core themes related to dietary adherence: control over food, dietary competence, commitment to support, spousal communication, and coping with diabetes. The themes can be categorized within two key social cognitive theory constructs: reinforcement and self-efficacy. Implications from the focus group data can inform the development of more effective, targeted nutrition messages and programs to provide specific knowledge and skills.

Is One Theory Better than Another in Nutrition Education? A Viewpoint: More Is Better

Health behavior theories describe the relations among variables influencing a behavior and specify targets for facilitating behavior change. Nutrition education does not have a dominant theory specific to the discipline. Instead, constructs from multiple theories have been borrowed, primarily from the social sciences, and have been applied to describe or predict nutrition-related behaviors. However, current theories do not fully predict behavior or behavior change. A more effective approach may be to integrate distinct constructs from competing theories into one or more polytheoretical models that can be empirically tested and refined into a more comprehensive, tailored theory or set of theories specific to food and nutrition behavior changes. In our view, more than one will be needed to address the complex array of people, issues, and contexts that we routinely address in nutrition education and behavioral interventions.

Evaluation of a Food Label Nutrition Intervention for Women with Type 2 Diabetes Mellitus

OBJECTIVEnTo evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus.nnnDESIGNnA pretest-posttest control group design. Participants received random group assignment.nnnSUBJECTS/SETTINGnForty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program.nnnINTERVENTIONnNine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubels learning theory were also incorporated into program design and evaluation.nnnMAIN OUTCOME MEASURESnThe effectiveness of the food label education program on participants knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants perceived confidence in using the food label. The validity and reliability of the instruments had been established previously.nnnSTATISTICAL ANALYSESnAnalysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results.nnnRESULTSnThe experimental group showed a greater gain than the control group in total knowledge (P < .001), declarative knowledge (P < .001), and procedural knowledge (P < .01) at posttest. Posttest data showed a significant increase (P < .01) in experimental participants perceived confidence in using the food label.nnnCONCLUSIONSnWomen with diabetes need more education about the food label. This intervention is an effective outpatient education program. Participant knowledge and perceived confidence in using the food label improved significantly as a result of the intervention. Future research should assess retention of knowledge gained and the impact of the intervention on metabolic measures of diabetes management and control.

Development and Validation of a Shelf Inventory to Evaluate Household Food Purchases Among Older Adults with Diabetes Mellitus

OBJECTIVEnValid measures of behavioral outcomes are needed to evaluate interventions. The purpose of this research was to validate a shelf inventory and evaluate food purchases using the inventory among older adults with diabetes.nnnDESIGNnA 166-item shelf inventory of household food was assessed for face, content, and criterion validity. The sensitivity and specificity of the inventory were determined by comparing participant- and interviewer-completed inventories. A randomized pretest/post-test control group design was used to evaluate household food purchases following an intervention.nnnSETTINGnThe intervention was held in an outpatient setting.nnnPARTICIPANTSnStudy participants were > or = 65 years old with type 2 diabetes mellitus for > or = 1 year.nnnINTERVENTIONnThe intervention included 10 weekly group sessions and emphasized applying food label information to food purchases.nnnMAIN OUTCOME MEASURESnEach food on the inventory was defined as encouraged or discouraged according to intervention messages.nnnANALYSISnInventory sensitivity was the proportion of foods present in households that were accurately identified on the self-reported inventory as present; specificity was the proportion of foods not present that were accurately identified as not present. Two-sample t tests compared intervention scores for encouraged/discouraged foods by treatment group.nnnRESULTSnOverall sensitivity and specificity were.90 and.97, respectively. Intervention results found more encouraged than discouraged foods present at post-test (t [91] = 2.3, P =.02).nnnCONCLUSIONS AND IMPLICATIONSnThe shelf inventory is a sensitive, specific, and valid tool for assessing household food purchases and can be used to evaluate food choice interventions among older adults with type 2 diabetes mellitus.

A randomized behavioural trial targeting glycaemic index improves dietary, weight and metabolic outcomes in patients with type 2 diabetes.

OBJECTIVEnGlycaemic index (GI) reflects the postprandial glucose response of carbohydrate-containing foods. A diet with lower GI may improve glycaemic control in people with diabetes. The purpose of the present study was to evaluate the change in outcomes following a behavioural intervention which promoted lower-GI foods among adults with diabetes.nnnDESIGNnA pre-test-post-test control group design was used with participants randomly assigned to an immediate (experimental) or delayed (control) treatment group. The intervention included a 9-week, group-based intervention about carbohydrate and the glycaemic index. Dietary, anthropometric and metabolic measures were obtained pre/post-intervention in both groups and at 18-week follow-up for the immediate group.nnnSETTINGnThe study was conducted in a rural community in the north-eastern USA.nnnSUBJECTSnAdults having type 2 diabetes mellitus for > or =1 year, aged 40-70 years and not requiring insulin therapy (n 109) were recruited.nnnRESULTSnFollowing the intervention, mean dietary GI (P < 0.001), percentage of energy from total fat (P < 0.01) and total dietary fibre (P < 0.01) improved in the immediate compared with the delayed group. Mean BMI (P < 0.0001), fasting plasma glucose (P = 0.03), postprandial glucose (P = 0.02), fructosamine (P = 0.02) and insulin sensitivity factor (P = 0.04) also improved in the immediate group compared with the delayed group. Mean waist circumference among males (P < 0.01) and body weight among males and females (P < 0.01) were significantly different between treatment groups.nnnCONCLUSIONSnEducating clients about carbohydrate and the glycaemic index can improve dietary intake and health outcomes among adults with type 2 diabetes.

Reliability and validity of a nutrition and food-label knowledge test for women with type 2 diabetes mellitus

Valid and reliable measures of nutrition knowledge are needed for program evaluation to develop predictive models of learning, food intake, and health behavior. The food label is an essential component of diabetes education. This study describes how an instrument designed to assess knowledge of food labels was pretested for reliability and validity. Five people assessed the test for face validity and rated the test at least 4 on a 5-point scale. The index of content validity was 0.76 based on a review of the test by five dietitians. The test was used to evaluate a nutrition intervention for women with diabetes using a pretest/post-test control-group design (n = 43). The coefficient of stability was 0.86 using the test–retest method among participants in the control group. The reliability estimate for internal consistency was 0.81 based on Kuder-Richardson formula 20. Item analysis found individual questions to be within acceptable limits. Participants in the experimental group showed significant gains in knowledge at post-test (p < .01), supporting the instructional sensitivity of the test. The approach used to assess the reliability and validity of an instrument was feasible and effective and is recommended prior to implementing a test for outcome evaluation.

Knowledge of dietary supplement label information among female supplement users

The use of dietary supplements is a popular form of health behavior, especially among women. Little research has been conducted to determine consumers comprehension of supplement label information. Therefore, this research evaluated comprehension of supplement label information among women 25-45 years of age who consumed a dietary supplement > or =4 times per week. Participants (n=51) completed a written questionnaire about supplement practices, a 10-item knowledge test, and an individual interview about terms used on supplement labels. Participants answered 70% of the questions correctly on the knowledge test indicating adequate knowledge of dietary sources of nutrients. Knowledge of recommended dosages, dosing instructions, and instructions about inappropriate use of supplements for certain people also was adequate. However, misconceptions regarding the term natural on supplement labels, product claims, and testing for product safety existed among participants. Supplement users need additional education about supplement claims and testing for product safety and efficacy to make informed health care choices.

Food purchase decision-making typologies of women with non-insulin-dependent diabetes mellitus

Food selection is a key factor in the nutritional management of diabetes mellitus. Since up to 80% of food purchase decisions are made at the supermarket, the purpose of this study was to identify the criteria which influence point-of-purchase decision-making in women with NIDDM aged 40-60 years. A qualitative approach with individual interviews and in-store observations was used. Analysis of the interviews identified four decision-making typologies based on the extent nutrition, price and family needs were emphasized. The four typologies included (1) the Overloaded Shopper, (2) the Budget Shopper, (3) the Nutrition Savvy Shopper, and (4) the Out-of-Touch Shopper. Cluster analysis confirmed the typologies for 71% of the sample. Educators should classify shoppers according to a typology to determine their clients personal needs and interests. Then, educators can tailor the educational or counseling message to meet those specific needs.