SciELO - Scientific Electronic Library Online

 
vol.17 número1Incidence, severity and management of cancer chemotherapy related oral mucositis in Eastern Cape and Western CapePerceptions of registered nurses regarding factors influencing service delivery in expanding programmes in a primary healthcare setting índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Artigo

Indicadores

Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google

Compartilhar


Health SA Gesondheid (Online)

versão On-line ISSN 1025-9848

Health SA Gesondheid (Online) vol.17 no.1 Cape Town  2012

 

ORIGINAL RESEARCH

 

Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

 

 

Jane W. MuchiriI; Gerda J. GerickeI; Paul RheederII

IDepartment Human Nutrition, University of Pretoria, South Africa
IISchool of Health Systems and Public Health, University of Pretoria, South Africa

Correspondence

 

 


ABSTRACT

Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE) could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample) and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger's framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary practices and barriers are issues that need addressing in an NE programme, whilst the suggestions for an NE programme and facilitators to dietary compliance need to be incorporated.


OPSOMMING

Onderrig in die selfbestuur van diabetes is essensieel in diabetessorg. Onderrig wat spesifiek ooreenkomstig die behoeftes van die pasiënt aangepas is, word die mees doeltreffend in die verbetering van gesondheiduitkomste geag. Dieet, 'n kritiese element in diabetesbehandeling, word deur pasiënte en gesondheidpraktisyns as die moeilikste beskou om na te volg. Spesifiek beplande voedingonderrig kan tot voordeel van lae sosio-ekonomiese diabete wees wat deel van diegene wat swak gesondheiduitkomste toon, uitmaak. Die doel van hierdie kwalitatiewe interpreterende fenomologiese studie was om die voedingonderrigbehoeftes van volwassenes met tipe 2 diabetes mellitus te ondersoek en te beskryf ten einde die ontwikkeling van 'n voedingonderrigprogram wat op hulpbrondbeperkte omgewings afgestem is, te rig. Een en dertig nie-insulien afhanklike tipe 2 diabetes pasiënte (geriefsteekproef) en 10 gesondheidpraktisyns was evalueer. Fokusgroepbesprekings deur gebruikmaking van semi-gestruktureerde vrae, is met die diabete gehou. Self-geadministreerde oop-eindigende vraelyste is deur die gesondheidpraktisyns voltooi. Data-analise is volgens Krueger se raamwerkbenadering gedoen. Siekteverwante kennisgapings en ontoepaslike self-gerapporteerde dieetpraktyke, insluitend ongebalanseerde maaltye, probleme met porsiekontrole en ontoereikende inname van groente en vrugte is gerapporteer. Aanbevelings vir die voedingonderrigprogram het onderwerpe verwant aan die siekte en die dieet ingesluit. Die pasiënte het groeponderrig by die kliniek, 'n bevoegde onderrigpraktisyn en omvattende onderrig verkies. Die pasiënte en die gesondheidpraktisyns het gesinsdeelname en die beskikbaarstelling van pamflette aanbeveel. Struikelblokke wat negatief op die voedingonderrigprogram kon inwerk, het finansiële beperkinge, voedselinsekuriteit, konflik met gesinsmaaltydreëlings en toegang tot geskikte voedsels ingesluit. Ondersteuning van die gesin en gesondheidpraktisyns, sowel as bemagtiging deur kennis is as fasiliteerders ter bevordering van die navolging van dieetaanbevelings deur beide groepe deelnemers geïdentifiseer. Tekortkominge in kennis, ontoepaslike dieetpraktyke en struikelblokke is aspekte wat in 'n voedingonderrigprogram aangespreek behoort te word. Voorstelle wat vir die voedingonderrigprogram en fasiliteerders gemaak is vir dieetnavolging, behoort in die program ingesluit te word.


 

 

“Full text available only in PDF format”

 

 

References

Albarran, N.B., Ballesteros, M.N., Morales, G.G. & Ortega, M.I., 2006, 'Dietary behaviour and type 2 diabetes', Patient Education & Counseling 61, 191-199. http://dx.doi.Org/10.1016/j.pec.2005.03.008        [ Links ]

Albright, T.L., Parchman, M. & Bürge, S.K., 2001, 'Predictors of self-care behaviour in adults with type 2 Diabetes: An RRNeST Study', Family Medicine 33(5), 354-360.         [ Links ]

American Dietetic Association, 1996, 'Nutrition education for the public', Journal of the American Dietetic Association 96(11), 1183-1187.         [ Links ]

Anderson-Loftin, W., Barnett, S., Sullivan, P., Bunn, P.S. & Tavakoli, A., 2002, 'Culturally competent dietary education for southern rural African Americans', Diabetes Educator 28(2), 245-257. http://dx.doi.org/10.1177/014572170202800210        [ Links ]

Babbie, E.R., Mouton, J., Vorster, P. & Prozesky, B., 2001, The practice of social research, Oxford University Press, Cape Town.         [ Links ]

Badruddin, N., Basit, A., Hydrie, M.Z.I. & Hakeem, R., 2002, 'Knowledge, attitudes and practices of patients visiting a diabetes care unit', Pakistan Journal of Nutrition 1(20), 99-102.         [ Links ]

Benavides-Vaello, S., Garcia , A.A., Brown, S.A. & Winchell, M., 2004, 'Using focus groups to plan and evaluate diabetes self-management interventions for Mexican Americans', Diabetes Educator 30(2), 238-256. http://dx.doi.org/10.1177/014572170403000217        [ Links ]

Blancard, M.A., Rose, L.E., Taylor, J., McEntee, M.A. & Latchaw, L.L., 1999, 'Using focus groups to design a diabetes education program for an African American population', Diabetes Educator 25(6), 917-925. http://dx.doi.org/10.1177/014572179902500609        [ Links ]

Brown, S.A. & Hanis C.L., 1999, 'Culturally competent diabetes education for Mexican Americans: The Starr Country study', Diabetes Educator 25(2), 226-236. http://dx.doi.org/10.1177/014572179902500208        [ Links ]

Brown, S.A., 1999, 'Interventions to promote diabetes self-management: state of art science', Diabetes Educator 25(6), S52-S61.         [ Links ]

Brown, S.A., Garcia, A., Koukezani, K. & Hanis, C.L., 2002, 'Culturally competent diabetes self-management education for Mexican Americans: The Starr County Border Health Initiative', Diabetes Care 25(2), 259-268. http://dx.doi.org/10.2337/diacare.25.2.259        [ Links ]

Carbone, E.T., Rosal, M.C., Torres M. I., Goins, K.V. & Bermudez, 2007, 'Diabetes self-management: perspectives of Latino patients and their health care providers', Patient Education & Counseling 66, 202-210. http://dx.doi.org/10.1016/j.pec.2006.12.003        [ Links ]

Chlebowy, D.O., Hood, S. & LaJoie, S., 2010, 'Facilitators and barriersto self-management of type 2 diabetes among urban American adults: Focus group findings', Diabetes Educator 36(6), 897-905. http://dx.doi.org/10.1177/0145721710385579        [ Links ]

Clark, M., Hampson, S.E., Avery, H. & Simpson, R., 2004, 'Effects of a tailored lifestyle self management intervention in patients with type 2 diabetes mellitus', British Journal of Health Psychology 9(3), 365-379. http://dx.doi.org/10.1348/1359107041557066        [ Links ]

Colleran, K.M., Starr B. & Burge, M.R., 2003, 'Putting Diabetes to the Test. Analyzing glycemic control based on patients' diabetes knowledge', Diabetes Care 26(7), 2220-2221. http://dx.doi.org/10.2337/diacare.26.7.2220        [ Links ]

Cox, R.H., Carpenter, J.P., Bruce, S.A., Poole, K.P. & Gaylord, C.K., 2004, ' Characteristics of low-income African-American and Caucasian adults that are important in self-management of type 2 diabetes', Journal of Community Health 29(2), 155-577. http://dx.doi.org/10.1023/B:JOHE.0000016719.89848.b1        [ Links ]

Department of Health, Directorate of Chronic Diseases, Disabilities & Geriatrics, 2005, National guideline: Management of diabetes type 1 and type 2 in adults at hospital level, Annexure 4, pp. 46-47, Depatment of Health, Pretoria.         [ Links ]

Dye, C.J., Haley-Zitlin, V. & Willoughby, D., 2003, 'Insights from older adults with type 2 diabetes: Making dietary and exercise changes', Diabetes Educator 29(1), 116-127. http://dx.doi.org/10.1177/014572170302900116        [ Links ]

Ellis, E.E., Speroff, T., Dittus, R.S., Brown, A., Pichert, J.W. & Elasy, T.A., 2004, 'Diabetes patient education: A meta-analysis and meta-regression', Patient Education & Counseling 52, 97-105. http://dx.doi.org/10.1016/S0738-3991(03)00016-8        [ Links ]

Fouche, C.B., 2005, 'Qualitative research designs', in A.S. De Vos, H. Strydom, C.B. Fouche & C.S.L. Delport (eds.), Research at the grass root for the social sciences and human service professions, 3rd edn., pp. 263-273, Van Schaik Publishers, Pretoria.         [ Links ]

Funnell, M.M., Brown, T.L., Childs, B.P., Haas, L.B., Hosey, G.M., Jensen, B. et al., 2009, 'National standards for diabetes self-management education', Diabetes care 32, suppl. 1, S87-S94. http://dx.doi.org/10.2337/dc09-S087        [ Links ]

Gallant, M.P., 2003, 'The influence of Social support on chronic illness self-management: A review and directions for research', Health Education & Behaviour 30(2), 170-195. http://dx.doi.org/10.1177/1090198102251030        [ Links ]

Glazier, R.H., Bajcar, J., Kennie, N.R. & Wilson, N.K., 2006, 'A systematic review of interventions to improve diabetes care in socially disadvantaged populations', Diabetes Care 29(7), 1675-1688. http://dx.doi.org/10.2337/dc05-1942        [ Links ]

Golay, A., Lagger, G., Chambouleyron, M., Carrard, I. & Lasserre-M., 2008, 'Therapeutic education of diabetic patient', Diabetes/Metabolism Research & Reviews 24, 192-196. http://dx.doi.org/10.1002/dmrr.798        [ Links ]

Greef, M., 2005, 'Information collection: interviewing', in A.S. De Vos, H. Strydom, C.B. Fouche & C.S.L Delport (eds.), Research at the grass root for the social sciences and human service professions, 3rd edn., pp. 286-313, Van Schaik Publishers, Pretoria.         [ Links ]

Gwatkin, D., Guillot, M. & Heuveline, P., 1999, 'The burden of disease among the global poor', Lancet 354, 586-589. http://dx.doi.org/10.1016/S0140-6736(99)02108-X        [ Links ]

Holmstrom, I. & Rosenqvist, U., 2005, 'Misunderstanding about illness and treatment among patients with type 2 diabetes', Journal of Advanced Nursing 49(2), 146-154. http://dx.doi.org/10.1111/j.1365-2648.2004.03274.x        [ Links ]

International Diabetes Federation, 2009, 'International standards for diabetes education', 3rd edn., viewed 19 April 2012, from http://www.idf.org/flles/docs/INTNL-STANDARDS-EN.pdf        [ Links ]

International Diabetes Federation, 2011, 'Types of diabetes', viewed 19 April 2012, from http://www.idf.org/types-diabetes.         [ Links ]

Jazayeri, S.M.H.M. & Pipelzadeh, M.H., 2006, 'Barriers to diet self-care in outpatients with type 2 diabetes in Iran', Pakistan Journal of Medical Sciences 22(4), 412-415.         [ Links ]

Kidd, P.S. & Parshall, M.B., 2000, 'Getting the focus and the group: Enhancing analytical rigor in focus group research', Qualitative Health Research 10(3), 293. http://dx.doi.org/10.1177/104973200129118453        [ Links ]

Levetan, B.N., Levitt, N.S. & Bonnici, F., 1997, 'Hyperglycemic emergencies are a common problem', South African Medical Journal 87, 368-370.         [ Links ]

Lopez, K.A. & Willis, D.G., 2004, 'Descriptive versus interpretive phenomenology: Their contributions to nursing knowledge', Qualitative Health Research 14(5), 726-735. http://dx.doi.org/10.1177/1049732304263638        [ Links ]

Marcy, T.R., Britton, M.L. & Harrison, D., 2011, 'Identification of barriers to appropriate dietary behaviour in low-income patients with type 2 diabetes mellitus', Diabetes Therapy 1(2), 1-11.         [ Links ]

Moretele Local Municipality, 2008/2009, Reviewed integrated development plan (IDP), Moretele Local Municipality, Makapanstad.         [ Links ]

Muchiri, J.W., Gericke, G. & Rheeder, P., 2009, 'Elements of effective nutrition education for adults with diabetes mellitus in resource-poor settings: A review', HealthSA Gesondheid 14(1), viewed 21 June 2011, from http://dx.doi.org/10.4102/hsag.v17i1.621        [ Links ]

Nagelkerk, J., Reick, K. & Meengs, L., 2006, 'Perceived barriers and effective strategies to diabetes self-management', Journal of Advanced Nursing 54(2), 151-158. http://dx.doi.org/10.1111/j.1365-2648.2006.03799.x        [ Links ]

Nelson, K.N., Reiber G. & Boyko E.J., 2002, 'Diet and exercise among adults with type 2 diabetes: Findings from the third National Health and Nutrition Examination Survey (NHANES III)', Diabetes Care 25(10), 1722-1728. http://dx.doi.org/10.2337/diacare.25.10.1722        [ Links ]

Norlyk, A. & Harder, I., 2010, 'What makes a phenomenological study phenomenological? An analysis of peer-reviewed empirical studies', Qualitative Health Research 20(3), 420-431. http://dx.doi.org/10.1177/1049732309357435        [ Links ]

Norris, S.L., Engelgau, M.M. & Narayan, K.V., 2001, 'Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials', Diabetes Care 24(3), 561-587.         [ Links ]

Norris, S.L., Lau, J., Smith, S.J., Schmid, C.H. & Engelgau, M.M., 2002, 'Self-management education for adults with type 2 diabetes: a meta-analysis of effect on glycemic control', Diabetes Care 25(7), 1159-1171. http://dx.doi.org/10.2337/diacare.24.3.561        [ Links ]

Nthangeni, G., Steyn, N.P., Alberts, M., Steyn, K., Levitt, N.S., Laubscher, R. et al., 2001, 'Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services', Public Health Nutrition 5(2), 329-338.         [ Links ]

Pastors, J.G., Warshaw, H., Daly, A., Franz, M. & Kulkani, K., 2002, 'The evidence for the effectiveness of medical nutrition therapy in diabetes management', Diabetes Care 25(3), 608-613. http://dx.doi.org/10.2337/diacare.25.3.608        [ Links ]

Persell, S.D., Keating, N.L., Landrum, M.B., Landon, B.E., Ayanian, J.Z., Borbas, C. et al., 2004, 'Relationship of diabetes-specific knowledge to self-care activities, ambulatory preventive care and metabolic outcomes', Preventive Medicine 39, 764-752. http://dx.doi.org/10.1016/jJ.ypmed.2004.02.045        [ Links ]

Rabiee, F., 2004,'Focus-group interview and data analysis', Proceedings of the Nutrition Society 63, 655-660. http://dx.doi.org/10.1079/PNS2004399        [ Links ]

Roper, N.A., Bilous, R.W., Kelly, W.F., Unwin, N.C. & Connolly, V.M., 2001, 'Excess mortality in a population with diabetes and the impact of material deprivation: Longitudinal, population based study', British Medical Journal 322, 1389-1393. http://dx.doi.org/10.1136/bmj.322.7299.1389        [ Links ]

Rosal, M.C., Goins, K.V., Carbone, E.T. & Cortes, D.E., 2004, 'Views and preferences of low-literate Hispanics regarding education: Results of formative research', Health Education & Behavior 31(3), 388-405. http://dx.doi.org/10.1177/1090198104263360        [ Links ]

Shabbidar, S., Fathi, B. & Shirazifard, N.M., 2006, 'Effects of clinical nutrition education on glycemic control outcomes in type 2 diabetes', International Journal of Diabetes in Developing Countries 26(4), 165-169. http://dx.doi.org/10.4103/0973-3930.33181        [ Links ]

Shaw, J.E., Sicree, R.A. & Zimmet, P.Z., 2010, 'Global estimates of the prevalence of diabetes for 2010 and 2030', Diabetes Research and Clinical Practice 87(1), 4-14. http://dx.doi.org/10.1016/j.diabres.2009.10.007        [ Links ]

Shultz, J.A., Sprague, M.A., Branen, L.J. & Lambeth, S., 2001, 'A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise', Journal of Health Communication 6, 99-115. http://dx.doi.org/10.1080/108107301750254457        [ Links ]

Speziale, H.J.S. & Carpenter, D.R., 2007, Qualitative research in nursing. Advancing the humanistic imperative, 4th edn., Lippincott Williams & Wilkins, Philadelphia.         [ Links ]

Suhl, E. & Bonsignore, P., 2006, 'Diabetes self-management education for older adults: General principles and practical application', Diabetes Spectrum 19(4), 234-240. http://dx.doi.org/10.2337/diaspect.19.4.234        [ Links ]

Sullivan, E.D. & Joseph, D.H., 1998, 'Struggling with behaviour changes: a special case for clients with diabetes', Diabetes Educator 24, 72-77. http://dx.doi.org/10.1177/014572179802400110        [ Links ]

Two Feathers, J., Kieffer, E.C., Palmisano, G., Anderson, M., Guzman, N. & James S.A., 2007, 'The development, implementation, and process evaluation of the REACH Detroit Partnership's Diabetes', Diabetes Educator 33(3), 509-520.         [ Links ]

Van den Arend, I.J., Stolk R.P., Rutten, G.E. & Schrijvers, G.J., 2001, 'Education integrated into structured general practice care for type 2 diabetic patients' results in improvement of disease knowledge and self-care', Diabetes Medicine 17(3), 190-197. http://dx.doi.org/10.1046/j.1464-5491.2000.00232.x        [ Links ]

Vijan, S., Stuart, N.S., Fitzgard, J.T., Ronis, D.L., Hayward, R.A., Slater, S., & Hofer T.P., 2005, 'Barriers to following dietary recommendations in type 2 diabetes', Diabetes Medicine 22, 32-38. http://dx.doi.org/10.1111/j.1464-5491.2004.01342.x        [ Links ]

Vincent, B., Clark, L., Marquez, L., Zimmer, L. & Sanchez, J., 2006, 'Using Focus Groups to develop a culturally competent diabetes self-management program for Mexican Americans', Diabetes Educator 32(1), 89-97. http://dx.doi.org/10.1177/0145721705284372        [ Links ]

Viswanath, K. & Bond, K., 2007, 'Social determinants and nutrition: Reflections on the role of communication', Journal of Nutrition Education & Behaviour 39, S20-S24. http://dx.doi.org/10.1016/jjneb.2006.07.008        [ Links ]

Vorster, H.H. (ed.), 2001, 'South African Food Based Dietary Guidelines', South African Journal of Clinical Nutrition 14(3), Suppl. S1-S80.         [ Links ]

Wen, L.K., Parchman, M.L. & Shepherd, M.D., 2004, 'Family support and diet barriers among older Hispanic adults with type 2 Diabetes', Family Medicine 36(6), 423-430.         [ Links ]

Zimmet, P., 2003, 'The burden of type 2 diabetes: are we doing enough?', Diabetes & Metabolism 29(4), 6S9-6S18.         [ Links ]

 

 

Correspondence:
Jane Muchiri
Private Bag X323
Pretoria 0001
South Africa
Email: jane.muchiri@up.ac.za

Received: 21 July 2011
Accepted: 13 July 2012
Published: 18 Oct. 2012

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License