A model exploring the relationship between nutrition knowledge, behavior, diabetes self-management and outcomes from the dining with diabetes program

Abstract

To examine the relationship between changes in participant's knowledge, beliefs, dietary behavior, diabetes self-management and program outcomes in West Virginia Dinning with Diabetes (DWD) program. We used a longitudinal pre-test and post-test study design and data from 2745 individuals with diabetes who participated from 2007 to 2012. The DWD was offered in community-based settings across the state as an educational program (five classes over a 3-month period). Associations between changes in the variables were examined by structural equation modeling using a path model in which changes in nutritional knowledge, beliefs and depression predicted changes in dietary behaviors and diabetes self-management which subsequently predicted program outcomes (e.g., follow-up with healthcare providers for diabetes care and education). Standardized regression weights are presented. Participant's mean age and duration of diabetes was 63 ± 11.5 and 7.2 ± 8.0 years, respectively. The majority were females, Whites and with less than high school education. Improvements in nutrition knowledge and belief predicted improvements in dietary behavior (β = 0.60, p < .001 and β = 0.11, p < .001, respectively) and diabetes self-management (β = 0.61, p < .001 and β = 0.10, p < .001, respectively) which in turn predicted improvements in program outcome (β = 0.41, p < .001). Diabetes self-management mediated the relationship between knowledge, dietary behavior and program outcomes. The indexes of fit for the tested model indicated a good fit [TLI =0.99, CFI = 0.95, and Root Mean Square Error of Approximation (RMSEA) =0.05]. Results indicate DWD group sessions can be effective in supporting individuals with diabetes to change knowledge, dietary behaviors, adherence to self-management and follow-up provider visits for diabetes care.