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Barriers to changing dietary behavior

Authors:
  • World Diabetes Foundation

Abstract and Figures

Dietary change requires giving up long established patterns of eating behavior and acquiring new habits. 'Non-compliance' to diet advice may be a result of inability to provide diet self-management training and getting the right messages across to change eating behavior. Using a pre-tested questionnaire based interview, we carried out a study amongst 350 adults (> 20 years) with type 2 diabetes from two metro cities in South India, who had previously received diet advice with the objective to understand perceptions, attitudes and practices, as well as study factors that enhance or reduce compliance to diet advice. Ninety six patients (28%) followed diet for the full duration of diabetes (Group1), 131 (38%) followed diet for a partial duration varying between more than a quarter to three quarters of the total diabetes duration (Group 2) and 115 (34%) did not follow diet advice (Group 3) - followed for a duration less than a quarter of their diabetes duration. Study results show that many factors both patient and health care provider related influence outcomes of dietary advice. Factors that have a positive impact on compliance are - older age, shorter duration, nuclear family, good family support, less busy work life, higher health consciousness, advice given by dietician, more frequent visits to dietician, advice that includes elements to promote overall health not merely control of blood sugar, diet counseling that is easy to understand and use and includes healthy food options, cooking methods, practical guidance to deal with lifestyle issues. We conclude that patient barriers related to life circumstance are mostly non-modifiable, most modifiable barriers are related to behavioural aspect and the inability of the health care provider to provide individualized diet advice and self management training. Efforts must be made to improve counseling skills.
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I
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    
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  
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  
... In addition, some women were confused over the messages conveyed by the health care providers or even received erroneous or conflicting information. Kapur et al. reported that dietary change requires giving up long established patterns of eating behavior and acquiring new habits [48]. 'Non-compliance' to diet advice may be a result of the inability of the health care system to provide diet self-management training for women with GDM. ...
... The women's family, including her in-laws, was a very strong influencing factor for the women's ability, motivation and opportunity to follow the treatment. Family support is very important in dietary adherence, particularly if food does not have to be cooked separately and the whole family eats the same food [48]. Support from the family could mitigate many of the other barriers, but the family can also enhance them. ...
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Gestational diabetes mellitus (GDM) is associated with a range of adverse pregnancy outcomes as well as increased risk of future type 2 diabetes and cardiovascular disease. In India, 10%–35% of pregnant women develop GDM. In this study, we investigated women’s experiences with the dietary and pharmaceutical treatment for GDM in rural and urban Tamil Nadu, India. Semi-structured interviews were conducted with 19 women diagnosed with GDM. Data were analyzed using qualitative content analysis. Three overall aspects were discovered with several sub-aspects characterizing women’s experiences: emotional challenges (fear and apprehension for the baby’ health and struggling to accept a treatment seen as counterintuitive to being safe and healthy), interpersonal challenges (managing treatment in the near social relations and social support, and coordinating treatment with work and social life), and health system-related challenges (availability and cost of treatment, interaction with health care providers). Some aspects acted as barriers. However, social support and positive, high-quality interactions with health care providers could mitigate some of these barriers and facilitate the treatment process. Greater efforts at awareness creation in the social environment and systemic adjustments in care delivery targeting the individual, family, community and health system levels are needed in order to ensure that women with GDM have the opportunity to access treatment and are enabled and motivated to follow it as well.
... One must remember that expectations on the real-life effects of educational interventions in healthy individuals are low as unsolicited advice is rarely complied with, there is an inherent resistance to changing habits (dietary advice is the most common reference in this respect; Kapur et al., 2008;Martis et al., 2018), and this is even more pronounced in healthy individuals, who have limited incentive to do so. Also, although we opted for a comprehensive baseline sleep-wake assessment, the intervention was circadian in its essence and meant to affect sleep timing rather than sleep quality variables, which is what happened until T10, which corresponded to the last time of data collection before the transition from DST to ST. ...
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The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n = 5,740) received one of two sets of circadian hygiene advice (“A regular life” or “Bright days and dark nights”). Every month, they were then asked how easy it had been to comply and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n = 5,972) and examination (n = 1,800) timings, plus lecture attendances (n = 25,302). Fifty-two percent of students had poor sleep quality, and 82% showed signs of social jetlag. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less social jetlag, and later sleep habits. Over approximately a year, the “Bright days and dark nights” advice resulted in significantly earlier get-up times compared with the “A regular life” advice. Similarly, it also resulted in a trend toward earlier midsleep (i.e., the midpoint, expressed as clock time, between sleep onset and sleep offset) and toward a decrease in the latency between wake-up and get-up time, with no impact on sleep duration. Significant changes in most sleep quality and sleep timing variables (i.e., fewer night awakenings, less social jetlag, and delayed sleep timing during lock-down) were observed in both advice groups over approximately a year, mostly in association with pandemic-related events characterizing 2020. Early chronotype students had better academic performances compared with their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject (science and technology, health and medical, or social and humanities) were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.
... Although information on quantitative assessment of dietary practices is widely available, literature on qualitative assessment of diet-related self-care practices is limited. [15][16][17][18] It is very much important to understand the culture-specific facilitating and hindering factors that influence the adoption of healthy dietary practices among patients with diabetes and hypertension. Hence, the current qualitative study was conducted to assess the current dietary practices in diabetic and hypertensive patients and to study the barriers to dietary modifications and compliance in the service area of a rural health center in Puducherry. ...
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BACKGROUND: Healthy dietary practice is an important lifestyle modification and one of the key adjuncts to pharmacotherapy in the management of diabetes and hypertension. AIM AND OBJECTIVE: This study aims to describe the awareness regarding healthy dietary practices among diabetic and hypertensive patients in a rural health center, and to identify the barriers to dietary modifications and compliance among them. MATERIALS AND METHODS: Eight focus group discussions (FGDs) were conducted in this qualitative study among diabetic and/or hypertensive patients (homogenous groups, with 6–10 members) both in the special clinic as well as in the community setting of Ramanathapuram, in rural Puducherry. Verbatim group transcriptions were analyzed by systematic text condensation. RESULTS: Four themes – “awareness toward dietary modification,” “compliance to dietary modification,” “family support in following dietary modification,” and “barriers faced in following dietary modification” emerged after the analysis of all FGDs. Most of the patients were aware regarding the dietary modifications, but few comply with the modifications due to the barriers such as lack of time, financial constraints, and inadequate family support. Other barriers in following the dietary changes include fear of taboo in social gatherings and inability to deviate from traditional food habits. CONCLUSION: Despite good awareness, compliance to healthy dietary practices was poor owing to several barriers. Nutrition education sessions need to be conducted considering locally available resources and addressing the commonly encountered barriers in a simple and comprehensible manner involving family members/caregivers in addition to the patients
... Third,Kapur K et .al(2008) (27)who had carried out study about Barriers to changingdietary behavior. They found respondents' drug compliance increased with increasing level of education. ...
... Third,Kapur K et .al(2008) (27)who had carried out study about Barriers to changingdietary behavior. They found respondents' drug compliance increased with increasing level of education. ...
... Similarly, women living in the nuclear family system were more likely to follow 'nutrient-dense' dietary pattern compared to those living in joint family system. Previously, nuclear family has been found an important factor that had positive effect on modification of dietary behavior [20]. ...
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Dietary patterns vary greatly by race, ethnicity and region. Assessment of the dietary patterns of specific population groups improves our understanding of the complex relationship between diet and risk of chronic diseases. This cross-sectional study was conducted to identify major dietary patterns among minority women and to assess socioeconomic, lifestyle and health factors associated with them. Total of 250 women aged > 18 year, in pre-menopausal stage, non-pregnant and non-lactating, were randomly selected. Data on required parameters was collected using standardized questionnaires and tools. Factor analysis was conducted to extract major dietary patterns while analysis of covariance was fitted to investigate association between socioeconomic, lifestyle and health factors and adherence to these dietary patterns. Two major dietary patterns, 'nutrient-dense' and 'energy rich' were extracted. Factors positively associated with 'nutrient-dense' dietary pattern included women's age (β=0.04, 95% CI=0.009-0.07, p<0.05), women's husband or head of household education level > 10 year (β=0.35, 95% CI=0.09-0.59, p<0.001), nuclear family system (β=0.31, 95% CI=0.03-0.59, p<0.05), positive medical history of chronic diseases such as hyperglycemia and hypertension (β=0.61, 95% CI=0.31-0.90, p<0.001) and existence of leisure time physical activity (β=0.37, 95% CI=0.16-0.58, p<0.001) while BMI was negatively associated with it (β=-0.04, 95% CI=-0.07-0.02, p<0.001). The study findings supported association between socioeconomic, lifestyle and health factors and adherence to a 'nutrient-dense' dietary pattern. It is therefore suggested considering all of these important factors when nutrition policies and programs are designed for women in general and those from minority community in specific.
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The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students, and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n=5740) received one of two sets of circadian hygiene advice ('A regular life' or 'Bright days and dark nights'). Every month, they were then asked how easy it had been to comply, and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n=5972) and exam (n=1800) timings, plus lecture attendances (n=25,302). 52% of students had poor sleep quality and 82% showed signs of sleep deprivation. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less sleep deprivation and later sleep habits. The 'Bright days and dark nights' advice resulted in earlier get-up time/midsleep compared to the 'A regular life' advice. Significant changes in most sleep quality and sleep timing variables were observed in both advice groups over time, also in relation to pandemic-related events characterising 2020. Early-chronotype students had better academic performances compared to their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.
Article
Patients report that adhering to diet is the most challenging aspect of diabetes management. Provision of diet education is often delegated to health care providers, despite a lack of nutrition education and training and limited awareness of environmental and cultural challenges faced by patients. Aim. We examined perceived barriers to diet self-management among low-income minority patients with type 2 diabetes and their health care providers within a single ecosystem, to test whether providers understood patient barriers. Method. We surveyed 149 members of a safety-net clinic (99 patients, 50 providers), using barriers derived from the literature. Binomial logistic regression was applied to investigate relationships between barriers and patients’ sociodemographic variables and Pearson’s χ ² was used to compare differences in perceived barriers between patients and providers. Results. Providers expressed divergent perceptions of patients’ barriers to healthy eating, including more total barriers and little agreement with patients on their relative importance. Largest differences in providers’ perceptions of patient barriers included poor motivation, high use of fast food, inadequate family support, and lack of cooking skills—all suggesting patient inadequacy. In contrast, patients showed evidence of high motivation—in rate of blood glucose measurement and desire for diet education. Patients identified primary care providers as a main source of nutrition education, yet providers indicated lack of time for diet discussion and preferred other staff do the teaching. Conclusion. The findings from this study strongly suggest that health systems need to consider patient, provider, and system barriers when implementing nutrition education and management programs.
Article
Medical nutrition therapy (MNT) is the bedrock for the management of gestational diabetes mellitus (GDM). Several different types of dietary approaches are used globally, and there is no consensus among the various professional groups as to what constitutes an ideal approach. The conventional approach of limiting carbohydrates at the cost of increasing energy from the fat source may not be most optimal. Instead, allowing higher levels of complex, low-to-medium glycaemic index carbohydrates and adequate fibre through higher consumption of vegetables and fruits seems more beneficial. No particular diet or dietary protocol is superior to another as shown in several comparative studies. However, in each of these studies, one thing was common – the intervention arm included more intensive diet counselling and more frequent visits to the dieticians. For MNT to work, it is imperative that diet advice and nutrition counselling is provided by a dietician, which is easy to understand and use and includes healthy food options, cooking methods, and practical guidance that empower and motivate to make changes towards a healthy eating pattern. Various simple tools to achieve these objectives are available, and in the absence of qualified dieticians, they can be used to train other health care professionals to provide nutrition counselling to women with GDM. Given the impact of GDM on the future health of the mother and offspring, dietary and lifestyle behaviour changes during pregnancy in women with GDM are not only relevant for immediate pregnancy outcomes, but continued adherence is also important for future health.
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We wanted to determine whether a simple tool characterizing readiness to change among patients before participating in a diabetes educational intervention successfully screens for patients who will achieve satisfactory clinical improvement. Fifty patients referred to a diabetes educational center with hemoglobin A1c levels of more than 9.0% were asked four questions before participation in a diabetes educational program. Patients were categorized into precontemplation-contemplation, preparation, and action stages of readiness to change. Intensive diabetes education was offered to all participants. Hemoglobin A1c levels were measured for 24 months after the educational program. Patients in preparation and actions stages achieved a significantly larger reduction in hemoglobin A1c levels in a shorter time than patients in the combined precontemplation-contemplation stage. Average change in hemoglobin A1c levels at 12 months was -1.06 +/- 1.80 (P = .17) for the precontemplation-contemplation stage, -1.82 +/- 1.84 (P = .006) for the preparation stage, and -2.56 +/- 2.12 (P = .0006) for the action stage. Patients had significantly more hemoglobin A1c measurements in the preparation stage (4.63 +/- 2.42, P = .036) and the action stage (4.94 +/- 2.38, P = .013) than patients in the precontemplation-contemplation stage (3.00 +/- 1.22) during the 24-month study. In this small population, stage of change as determined by a simple clinical tool was significantly associated with clinical improvement in hemoglobin A1c levels at 3 months after an educational intervention. Significant differences in clinical improvement between groups persisted for at least 12 months. This tool could be used to tailor the most effective clinical diabetes interventions for patients and to address the needs of patients in a more targeted manner.
Article
Objective: To determine in patients with type 2 diabetes the effects on quality of life (QOL) of therapies for improving blood glucose control and for improving blood pressure (BP) control, diabetic complications, and hypoglycemic episodes. Research design and methods: We performed two cross-sectional studies of patients enrolled in randomized controlled trials of 1) an intensive blood glucose control policy compared with a conventional blood glucose control policy, and 2) a tight BP control policy compared with a less tight BP control policy. Also undertaken was a longitudinal study of patients in a randomized controlled trial of an intensive blood glucose control policy compared with a conventional blood glucose control policy. Subjects' QOL was assessed before or at the time of randomization and from 6 months to 6 years after randomization. Two cross-sectional samples of type 2 diabetic patients were randomized to therapies for blood glucose control: 1) 2,431 patients, mean age 60, duration from randomization 8.0 years, completed a "specific" questionnaire covering four aspects of QOL, and 2) 3,104 patients, mean age 62, duration from randomization 11 years, completed a "generic" QOL measure. Of these samples, 628 and 747 patients, respectively, were also randomized to therapies for BP control. A sample of 122 non-diabetic control subjects, average age 62, were also given the specific questionnaire. A longitudinal sample of 374 type 2 diabetic patients randomized to either intensive or conventional blood glucose policies, mean age at randomization 52, were given the specific questionnaire. Sample-sizes at 6 months and 1, 2, 3, 4, 5, and 6 years after randomization were 322, 307, 280, 253, 225, 163, and 184, respectively. The specific questionnaire assessed specific domains of QOL, including mood disturbance (Profile of Mood State), cognitive mistakes (Cognitive Failures Questionnaire), symptoms, and work satisfaction; the generic questionnaire (EQ5D) assessed general health. Both questionnaires were self-administered. Results: The cross-sectional studies showed that allocated therapies were neutral in effect, with neither improvement nor deterioration in QOL scores for mood, cognitive mistakes, symptoms, work satisfaction, or general health. The longitudinal study also showed no difference in QOL scores for the specific domains assessed, other than showing marginally more symptoms in patients allocated to conventional than to intensive policy. In the cross-sectional studies, patients who had had a macrovascular complication in the last year had worse general health, as measured by the generic questionnaire, than those without complications, with scale scores median 60 and 78 respectively (P = 0.0006) and tariff scores median 0.73 and 0.83 respectively (P = 0.0012); more problems with mobility, 64 and 36%, respectively (P < 0.0001); and more problems with usual activities, 48 and 28% respectively (P = 0.0023). As measured by the specific questionnaire, they also showed reduced vigor (P = 0.0077). Patients who had had a microvascular complication in the last year reported more tension (P = 0.0082) and total mood disturbance (P = 0.0054), as measured by the specific questionnaire, than patients without complications. Patients treated with insulin who had had two or more hypoglycemic episodes during the previous year reported more tension (P = 0.0023), more overall mood disturbance (P = 0.0009), and less work satisfaction (P = 0.0042), as measured by the specific questionnaire, than those with no hypoglycemic attacks, after adjusting for age, duration from randomization, systolic BP, HbA1c, and sex in a multivariate polychotomous regression. Conclusions: In patients with type 2 diabetes, complications of the disease affected QOL, whereas therapeutic policies shown to reduce the risk of complications had no effect on QOL. It cannot be discerned whether frequent hypoglycemic episodes affect QOL, or whether patients with certain p
Article
The response to diet of 3,044 newly diagnosed diabetic patients with a fasting plasma glucose (mean ± 1 SD) of 12.1 ± 3.7 mmol/L, age 52 ± 8 years, and body weight 130% ± 26% ideal body weight has been studied. The reduction in the fasting plasma glucose was greater in those presenting with a high initial fasting plasma glucose and in those who lost more weight, but was not related to the degree of obesity. There was considerable variation in the response to dieting, but on average, patients presenting with a fasting plasma glucose of 10 to 12 mmol/L needed to lose 28% ideal body weight (18 kg) to attain a fasting plasma glucose less than 6.0 mmol/L. Sixteen percent of all patients achieved a near-normal (<6 mmol/L) fasting plasma glucose after 3 months' dieting, ranging from 50% of those presenting with fasting plasma glucose of 6 to 8 mmol/L to 10% of those with fasting plasma glucose of 16 to 22 mmol/L. In those who achieved less than 6.0 mmol/L, in the second 3 months the fasting plasma glucose increased by a mean of 0.4 mmol/L even though there was a further mean weight reduction of 2.1% ideal body weight (1.4 kg) in addition to their loss of 11.6% ideal body weight (8 kg) in the initial 3 months. This confirms that the decrease in fasting plasma glucose is determined more by the restriction of energy intake than by the body weight. Those who maintained their fasting plasma glucose at less than 6.0 mmol/L in the year following the initial 3-month dietary period lost a further 3% (2 kg) ideal body weight. The data confirm the value of dieting, but in view of the large weight loss and equivalent large reduction in energy intake required in most patients, it is not surprising that few patients achieve near-normal fasting plasma glucose concentrations by diet alone.
Article
How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
Article
The knowledge, attitude and self care regarding diabetes was assessed in 150 diabetics, residing in Pondicherry, using a pre-tested schedule addressing six areas of diabetic self-care. Observations made included the ability of the patients to test, interpret and record the result of urine examination; diet practices; and insulin use. The knowledge, attitude and practices of diabetics were less than satisfactory in all the areas of self-care. Up to 80 per cent had a complication or associated disease. Most of the patients appreciated the need for dietary care or medication, but only 50 per cent regulated their diet. Of the 97 per cent using anti-diabetic agents, some were using them harmfully. Only 10.6 per cent of the patients tested their urine, though 71 per cent were aware of the need for this. Only 34 per cent saw a physician regularly. None of the patients had any formal education regarding diabetes.
Article
The purpose of this study was to identify how selected factors influence patient use of diet regimens for diabetes and to determine the effect of demographic characteristics. A survey was conducted using a 75-item questionnaire designed to collect responses from people with non-insulin-dependent diabetes mellitus. Frequency distributions and chi-square analyses were performed on the survey data. Five significant relationships were identified: (1) age and emotions, (2) age and schedule, (3) gender and emotions, (4) use of a diet plan and being told why to control diet, and (5) use of a diet plan and return for follow-up education. Dietitians need to consider demographic characteristics to tailor education sessions and to focus on improving communication with patients to increase their understanding of diabetes. This study showed that increased education promoted increased adherence to dietary recommendations.
Article
To determine whether health care providers appropriately identify patients with poor glycemic control and to investigate reasons why providers may fail to intensify therapy in these patients. Our management protocol calls for providers to advance diabetes therapy in patients with fasting plasma glucose levels > 7.8 mmol/l or random plasma glucose levels > 10.0 mmol/l. During a 3-month period, providers completed a questionnaire at the end of individual patient visits by asking whether the patient was well controlled and whether therapy was advanced. If therapy was not advanced in patients perceived to have poor control, providers were asked to provide a justification. Providers appropriately identified 88% of well-controlled patients and 94% of patients with poor glycemic control. Out of 1,144 patient visits, control was reported to be good in 508 and poor in 636. In these 636 visits, therapy was advanced in 490 but not in 146 visits. The dominant reasons for failure to intensify therapy were the perception by the provider that control was improving (34%) or the belief that the patient was not compliant with diet or medications (25%). Less common reasons included acute illness, patient refusal, and recurrent hypoglycemia. Based on fasting glucose levels, protocol adherence was 55% before the questionnaire, 64% during the questionnaire (P = 0.006), and 63% afterwards. Providers in a specialty diabetes clinic appropriately classified patients according to glycemic control and tended to intensify therapy when indicated in most poorly controlled patients. Provider self-survey of behavior and decision making may be an effective strategy to improve adherence to management protocols.
Article
Although consumers say they are concerned about nutrition and are aware that eating a healthful diet is important for good health, this knowledge does not always translate into healthful diet behaviors or motivate behavior change. In an effort to better understand consumer attitudes about nutrition and to explore alternatives for communicating dietary advice in language that is meaningful and motivates behavior change, the International Food Information Council (IFIC) conducted qualitative research with consumers (using focus groups) and registered dietitians (using telephone interviews) in 1998 and 1999. Results of the research are presented using dietary fat as a case study. Findings from the IFIC research were reported to the Dietary Guidelines Advisory Committee to assist the Committee in developing meaningful and action-oriented dietary advice related to dietary fat for inclusion in the 2000 Dietary Guidelines for Americans that would be motivating and easy for consumers to implement. The recommendation to moderate fat intake in the new dietary guideline, "Choose a diet that is low in saturated fat and cholesterol and moderate in total fat" is consistent with communication recommendations in the IFIC research. Further, the moderate fat message is empowering because it suggests an achievable dietary regimen and reduces guilt and worry about foods. It allows flexibility to enjoy desired foods and promotes using common sense when it comes to diet. Several issues emerged from the IFIC research that apply to general nutrition communications with consumers, whether it be through national nutrition recommendations or in one-on-one counseling situations: to be effective, messages to consumers about nutrition, and specifically dietary fat, must address sources of discomfort about dietary choices; they must engender a sense of empowerment; and they should motivate both by providing clear information that propels toward taking action and appeals to the need to make personal choices.
Article
The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient-specific stages of change. The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. The patients were at different stages of change of diabetes-affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. Understanding patient-specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.
Article
To examine patient- and provider-reported psychosocial problems and barriers to effective self-care and resources for dealing with those barriers. Cross-sectional study using face-to-face or telephone interviews with diabetic patients and health-care providers in 13 countries in Asia, Australia, Europe and North America. Participants were randomly selected adults (n = 5104) with Type 1 or Type 2 diabetes, and providers (n = 3827), including primary care physicians, diabetes specialist physicians and nurses. Regimen adherence was poor, especially for diet and exercise; provider estimates of patient self-care were lower than patient reports for all behaviours. Diabetes-related worries were common among patients, and providers generally recognized these worries. Many patients (41%) had poor psychological well-being. Providers reported that most patients had psychological problems that affected diabetes self-care, yet providers often reported they did not have the resources to manage these problems, and few patients (10%) reported receiving psychological treatment. Psychosocial problems appear to be common among diabetic patients worldwide. Addressing these problems may improve diabetes outcomes, but providers often lack critical resources for doing so, particularly skill, time and adequate referral sources.