Subjects’ experiences of a nutrition education programme: a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa

Journal of Endocrinology, Metabolism and Diabetes of South Afri

2018

To inform the adaptation of an intervention from a primary healthcare setting to a tertiary setting, the dietary and related self-management challenges and education programme preferences of adults with type 2 diabetes (T2DM) were explored. Setting: A study was undertaken in a tertiary teaching hospital in Gauteng Province, South Africa. Methods: A qualitative approach was employed. Data were collected via focus-group discussions and open-ended selfadministered questionnaires from a convenient purposive sample of T2DM patients (n = 28; 40-70 years) and health professionals (n = 10) respectively. Data were analysed using a thematic framework method. Results: Participants revealed diabetes-related knowledge deficits and struggle with adhering to diet, exercise, medication and appointment keeping as problems affecting patients. They also perceived multiple barriers to effective self-management (financial constraints, unsupportive social and physical environments and personal factors). Patients perceived the challenges to greatly impact on their quality of life and consequently the motivation to self-care appropriately. Participants desired an education programme in the form of monthly group meetings with approaches to enhance learning (e.g. use of examples from peers and the provision of education materials). Strategies for motivating and sustaining programme participation (e.g. testimonials from successful participants) were perceived as necessary. Involving family was seen as a key support for positive behaviour change. Conclusion: In adapting the intervention, the participants' preferences for education need to be considered and the unique challenges addressed. In particular, strategies for enhancing the patients' motivation and the self-efficacy to effectively selfmanage are essential.

Section: Discussionmentioning

confidence: 99%

Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults

Journal of Endocrinology, Metabolism and Diabetes of South Afri

2018

“…They were also very satisfied with the programme. 35 appropriate dietary behaviours related to reducing starchy food portions and energy intake. 19 Starchy food portions (at 6 and 12 months) and energy intake (only at 12 months) were found to be significantly lower in the intervention group.…”

Section: Discussionmentioning

confidence: 99%

Impact of nutrition education on diabetes knowledge and attitudes of adults with type 2 diabetes living in a resource-limited setting in South Africa: a randomised controlled trial

Journal of Endocrinology, Metabolism and Diabetes of South Afri

2016

To evaluate the effect of a nutrition education (NE) programme on diabetes knowledge and attitudes of adults with type 2 diabetes mellitus (T2DM). Methods: Eighty-two adults (40-70 years) with poorly controlled T2DM (HbA 1c ≥ 8%) and attending two community health centres in Moretele, North West Province (South Africa) participated in a one-year randomised controlled trial. Participants were randomised to the intervention group (n = 41; 8 weekly group education (2-2.5 hours); follow-up meetings and education materials) or control group (education materials only). Diabetes Knowledge Form B assessed knowledge about diabetes. Diabetes Attitudes Scale-III assessed the attitudes towards diabetes and treatment. Assessments were done at 6 and 12 months. Analysis of co-variance compared the groups (baseline, age, gender and clinic adjustments). An intention-to-treat analysis was employed. Results: The intervention group had higher mean diabetes knowledge scores + 0.95 (p = 0.033) and + 2.05 (p < 0.001) at 6 and 12 months respectively. However, the scores were below 50%. Patient autonomy for diabetes attitudes was the only score significantly higher in the intervention group + 0.27 (p = 0.028) at 12 months. Conclusion: NE significantly improved diabetes knowledge in the intervention group, though not satisfactorily, but had limited effects on the attitudes towards diabetes.

“…Intervention core elements or active ingredients are critical programme components considered to make an intervention effective. 16,31 Evidence from the literature, 25,31 supported by qualitative evaluations of participants during implementation of the original NEP, 24 guided the identification of core elements. The applicability of the NEP in the new setting was assessed by combining results of the needs assessment with consultations with HPs including dietitians and doctors, and evidence from the literature.…”

Section: Identifying Behaviours Of Target and Behaviour Determinants mentioning

confidence: 99%

“…These elements possibly contributed to positive dietary behaviour by enhancing behaviour mediators, namely self-efficacy, knowledge and skills, and outcomes expectations. The elements include (i) the group delivery format, 34 (ii) face-to-face delivery plus provision of education materials in the form of a wall/fridge poster, 24,35 (iii) hands-on activities and demonstrations, 36 (iv) cultural appropriateness of the NEP, 36,37 (v) follow-up intervention, 35 and (vi) the use of multiple BCT evidenced to change dietary behaviour. 38 All of these elements could be carried over into the new setting.…”

Section: Behaviours Of Targets Behaviour Determinants and Logic Modementioning

confidence: 99%

“…6 Furthermore, participants had low attrition rates and high satisfaction with the programme and recommended that the programme be offered to other people with diabetes. 19,24 The NEP meets most of the criteria for suitable effective intervention programmes as described by Card et al, 15 including nutrition education interventions. 25 Thus, the NEP was considered suitable for adapting for use in people with T2DM in diverse settings, particularly in resource-limited settings.…”

Section: Introductionmentioning

confidence: 99%

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Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting

South African Journal of Clinical Nutrition

2019

Self Cite

The purpose of this study was to adapt a diabetes nutrition education programme (NEP) developed for a primary healthcare setting for implementation in a tertiary healthcare setting. This manuscript describes the processes and considerations that were made. Methods: Four key steps for adapting interventions identified from the literature were used. The steps included (i) assessing the needs and logic model of change, (ii) assessing the applicability of the NEP components to the new setting, (iii) making adaptations, and (iv) planning for implementation and evaluation. In the various steps, patients and health professionals were involved mainly using qualitative methods: needs assessment (n = 28 and n = 10), making adaptations (n = 10 and n = 10) respectively, and patients (n = 5) in step four. Findings: Knowledge, self-efficacy and outcome expectations were identified as the main behaviour determinants in tertiary patients; therefore, the adapted NEP retained social cognitive theory as its foundation. The adapted NEP included new behaviour change techniques, particularly self-monitoring (behaviour and outcome) and vicarious learning using testimonials of successful management. The adapted NEP retained the original NEP components except the vegetable gardening demonstration. By incorporating monthly, instead of weekly group training sessions, a session for setting individual goals, provision of a workbook and additional relevant information, the adapted NEP catered for the tertiary patients' needs. Conclusion: The comprehensive adaptation process involved input from key stakeholders, which increases the chances of intervention effectiveness. The adapted NEP is being implemented through a randomised controlled trial and its evaluation will illuminate the impact of the changes made to the original NEP.