Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.

OBJECTIVEBecause unplanned pregnancies could cause maternal-fetal complications for women with diabetes, family planning vigilance (FPV) is imperative. The aims of this article are to operationalize and describe FPV and examine the associations among FPV behaviors and diabetes self-care management (DSM) and health outcomes of women with type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSRetrospective data were used from a follow-up study of adult women with T1D who participated as adolescents in a preconception counseling (PC) intervention trial and matched comparison women with T1D who did not receive the adolescent PC intervention. Participants completed online questionnaires regarding family planning behaviors, DSM, and clinical and reproductive health outcomes.RESULTSParticipants (N = 102) were, on average, 23.7 years old (range 18–38) and 98.0% were white, 82.2% had some college, 25.8% were married, and 11.8% had biological children. Of those sexually active (n = 80, 78.4%), 50% were contraceptive vigilant and 11% were FPV (i.e., being contraceptive vigilant, receiving PC, and initiating discussions with health care professionals). Among FPV behaviors, only receiving PC and initiating discussion with health care professionals were correlated (r = 0.29, P = 0.010). Compared with nonvigilant women, contraceptive vigilant and FPV women used more effective contraceptive methods (P = 0.025) and experienced less diabetic ketoacidosis (P = 0.040) and hospitalizations (P = 0.064), whereas FPV women were aware of PC (P = 0.046) and younger when they received PC (P < 0.001). FPV components were associated with DSM and health outcomes (P < 0.05).CONCLUSIONSWomen with diabetes should be FPV, but few were. FPV women were more likely to have PC earlier and better health outcomes, supporting early PC intervention.

Nurses can be pivotal to providing diabetes education, including, preconception counseling (PC) to prevent pregnancy-related complications in women with diabetes. However, many health professionals, including nurses, have reported self-deficits in these areas due to a lack training or knowledge. Simulation is an effective educational strategy utilized in schools of nursing to enhance critical thinking, decision-making, skills building and increase knowledge. However, little is known about the effectiveness of using simulation to train nursing students in providing diabetes education and preconception counseling to patients. Therefore, this study examined the effectiveness of a newly developed diabetes education/PC simulation training program developed for nursing students. The sample was 30 junior level baccalaureate nursing students who completed pretest and posttest measures on their awareness and knowledge of diabetes, pregnancy and PC. We used the 45 min video of READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) PC program during the simulation training session because it is a validated evidenced-based, theory-driven program that targets female adolescents, and is endorsed by the American Diabetes Association. They also observed a live 10 minute simulation of actors portraying a diabetic educator and a diabetic female adolescent and their clinical interaction. Data were analyzed using a paired t-test. The mean pretest score was 9.33, while the mean posttest score was 15.00 with a statistically significant gain (t = 15.89; p = .000). Therefore, it appears that PC simulation may be an effective educational strategy to train nursing students on caring for women with diabetes. Disclosure J.L. Thurheimer-Cacciotti: None. D. Charron-Prochownik: None.