Evaluation of a theory-based nutrition intervention forolder adults with diabetes mellitus

Abstract

<h2>Abstract</h2> <b>Objective</b> To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus.<b>Design</b> A randomized pretest-posttest control group design was used. <b>Subjects/setting</b> Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. <b>Intervention</b> The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. <b>Main outcome measures</b> Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. <b>Statistical analyses performed</b> Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired <i>t</i> tests compared results within groups. <b>Results</b> Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean±standard error of the mean: 7.8±0.7) than the control group (0.2±0.7) (<i>P</i><.0001), positive outcome expectations (0.59±0.15 vs 0.06±0.15, <i>P</i>=.01), promoters of diabetes management (0.83±0.12 vs −0.09±0.18, <i>P</i><.001) and decision-making skills (5.1±0.5 vs 0.3±0.5, <i>P</i><.0001) and greater reduction in barriers to diabetes management (1.1±0.16 vs 0.34±0.16, <i>P</i><.01). No significant difference in negative outcome expectations occurred between groups at posttest. <b>Applications/conclusions</b> Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management. <i>J Am Diet Assoc. 2002;102:1069–1074,1079–1081</i>.