Dietary Adherence In Patients Research Articles

Relationship between Knowledge Level and Dietary Adherence in Patients with Type II Diabetes Mellitus at Pajang Health Center Surakarta

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Deficiency in glucose metabolism due to absolute or relative insulin deficiency leads to increased blood sugar levels beyond the established normal range; this condition is characterized by a collection of symptoms called diabetes mellitus. Dietary adherence in individuals with type II diabetes mellitus can be seen from their level of knowledge. The research aims to determine the relationship between the level of knowledge and dietary compliance in people with type II diabetes mellitus. This research is a quantitative research with a cross-sectional approach. This research was conducted in the Pajang Surakarta Community Health Center area on all Type II Diabetes Mellitus sufferers and was carried out in November 2023. The research population was all Diabetes Mellitus patients at the Pajang Surakarta Community Health Center, as many as 148 people. The research sampling technique was Consecutive Sampling, so the sample obtained was 60. Data was collected using questionnaires and interviews. Analysis of research data with bivariate analysis using the Chi-Square test. The research results show a real relationship between the knowledge level and diet adherence with a p-value = 0.040. The level of knowledge about Diabetes can influence adherence to a diabetes diet because patients need good knowledge regarding recognizing the signs and symptoms of DM, the risk of complications occurring, and care in treating Diabetes.</em> <em>Therefore, the role of health workers is needed to hold outreach activities to provide knowledge about diabetes mellitus, starting from the definition, signs and symptoms, risk factors, prevention methods and complications that occur by providing regular and scheduled counselling.</em><em></em></p><p> </p></td></tr></tbody></table></div><strong><em>Keywords: Dietary Adherence, Diabetes Mellitus, Knowledge</em></strong>

Investigating the relationship between inhibitory control and dietary adherence among patients with type 2 diabetes mellitus based on subjective and objective measures

BackgroundDietary management has been recommended as the cornerstone of type 2 diabetes mellitus (T2DM) management. However, low adherence to dietary recommendations has been identified in both developed and developing countries. Previous research suggests that inhibitory control influences eating behavior, but few studies have been conducted in patients with T2DM. Thus, we aimed to explore the relationship between inhibitory control and dietary adherence among patients with T2DM.MethodsA total of 393 patients with T2DM from the endocrinology departments of three tertiary hospitals in China were enrolled by the convenience sampling method. Dietary adherence was measured by the Dietary Behavior Adherence Scale for Patients with Type 2 Diabetes Mellitus. Additionally, inhibitory control was subjectively measured by the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) and objectively assessed by the stop signal task (SST) and the Stroop task. The relationship between inhibitory control and dietary adherence was analyzed using Pearson correlation analysis and hierarchical regression analysis.ResultsSubjectively measured inhibitory control had a significant predictive effect for dietary adherence after controlling for demographic and clinical variables. Adding the inhibitory control variable to the regression equation resulted in the following values: overall model F (19, 373) = 7.096, p < 0.001, increase in R2 value by 0.069, change in F (1, 373) = 35.219, p < 0.001. Similarly, the performance of the Stroop task had a significant predictive effect for dietary adherence to some foods, i.e., carbohydrate and fat. Adding the Stroop effect variable to the regression equation resulted in the following values: overall model F (19, 81) = 2.848, p = 0.005, increase in R2 value by 0.060, change in F (1, 81) = 8.137, p = 0.006.ConclusionsInhibitory control was a predictor of dietary adherence in patients with T2DM. Future interventions should investigate whether inhibitory control training results in the improvement of dietary adherence in patients with T2DM.

Factors Related to Diet Adherence in Diabetes Mellitus Patients: A Scoping Review

Diabetes Mellitus (DM) is a disease that causes increased blood glucose levels or hyperglycemia. High blood glucose levels can be controlled by following a diet program. Adherence to diet is one of the keys to stabilizing blood glucose and preventing complications. Therefore, this study aimed to determine the factors associated with dietary adherence in patients with diabetes mellitus based on a literature study of 12 journals. Journal searches were carried out on Google Scholar, PubMed, ScienceDirect, and ProQuest using the keywords Factors AND Associated AND Diet OR Dietary AND Adherence OR Compliance AND Diabetes Mellitus. The journals were then assessed for quality using the Joanna Briggs Institute and analyzed using qualitative descriptive analysis. Based on the analysis, there is a relationship between intrinsic factors (age, gender, marital status, occupation, place of residence, education level, income/economic, family type, level of knowledge, BMI, duration of illness, perception, self-motivation, smoking, and family history of DM) of 71% and extrinsic factors (social support, family support, caregiver category, diet monitoring, and selection of food types) of 29%. Based on the results, it can be concluded that these factors are related to dietary compliance, so it is hoped that various nursing strategies can be designed to help people with diabetes mellitus improve their adherence to diets.&#x0D; Keywords: Dietary Compliance, Factors Associated, Diabetes Mellitus

Determinants of Dietary Adherence Among Chinese Patients After Bariatric Surgery Based on the Attitude-Social Influence-Efficacy Model.

To explore main determinants of dietary adherence among Chinese patients after bariatric surgery based on the Attitude-Social influence-Efficacy (ASE) model. A cross-sectional survey was conducted by using convenience sampling method to select 288 participants in a tertiary hospital in Jiangsu, China. General information and disease-related information were collected as well as applying the Dietary Adherence Scale after Bariatric Surgery (DASBS) and Attitude-Social influence-Efficacy Questionnaire after Bariatric Surgery (ASEQBS). Univariate analysis, correlation analysis, and multivariate analysis were used to identify determinants of dietary adherence among patients after bariatric surgery. A total of 288 questionnaires were effectively collected. The mean DASBS score was 54.90 ± 10.08 among post-bariatric patients. Univariate analysis results showed that education level, time since surgery, smoking, exercise, participation in peer support groups, and participation in nutrition counseling had significant effects on postoperative diet adherence level of patients (P < 0.05). The correlation analysis results showed that the total score of dietary adherence was positively correlated with the total score of intention, attitude, social influence, and self-efficacy, and the correlation coefficients were 0.511, 0.550, 0.460, and 0.484, respectively (P < 0.05). The results of multiple linear regression analysis showed that time since surgery, attitude, intention, social influence, exercise, and self-efficacy entered the regression equation (P < 0.05). The standardized regression coefficients of attitude and intention are 0.237 and 0.196, respectively. The regression model could explain 44.0% of the total variation. The dietary adherence of Chinese post-bariatric patients is at an upper-middle level, which needs to be further improved. Time since surgery, exercise, intention, attitude, social influence, and self-efficacy had significant effects on patients' dietary adherence. Attitude had the greatest effect on dietary adherence, followed by intention. The results shed light on that these factors should be emphasized to take personalized intervention strategy in designing dietary intervention program, in order to improve the patient's dietary adherence and surgical outcomes.

Well-being and dietary adherence in patients with coeliac disease depending on follow-up

Objective It is not clear how follow-up of coeliac disease should be optimally organised. In Malmö, Sweden, patients are followed up by general practitioners (GP), but in Linköping by gastroenterologists (GE). The aim of this study was to investigate if there were any differences in well-being and dietary adherence depending on type of follow-up. Methods All adult patients with newly diagnosed biopsy-verified coeliac disease in the cities between 2010 and 2014 were offered to participate. Data was retrieved comprising demography, laboratory analyses, questionnaires (Gastrointestinal Symptoms Rating Scale, Short Health Scale, Multidimensional Fatigue Inventory, Psychological General Well-being Index and Short Form 36) and follow-up. Results In the GP cohort 39/73 patients and in the GE cohort 58/121 agreed to participate (mean age 43 and 44 years, 69 and 60% women, respectively). A follow-up to a dietician was carried out in 31% and 93% of patients, respectively (p < .001). In the GP group 28% had eaten gluten-containing food during the last 4 weeks compared to 9% in the GE group (p = .01). Despite this, no differences could be seen in vitamin or mineral levels. The questionnaires did not indicate any major discrepancies in subjective health. Conclusion Irrespective of the design of the follow-up physical and mental well-being were comparable. Dietary adherence was not quite as good in the GP group but follow-up in a primary care setting can still be a suitable and equivalent alternative. However, it is crucial that the dietary counselling is structured in a way that ensures dietary adherence.

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration Using Partial Least Squares Structural Equation Modeling.

Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110–0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103–0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.

Awareness and Dietary Adherence of Patients with Type 2 Diabetes Mellitus in the City of Mosul: A Cross-Sectional Study

Introduction In patients with type 2 diabetes mellitus, the primary ultimate objectives of treatment are to improve the quality of life and minimize severe long-term metabolic problems by reducing premature morbidity and mortality.1-5 The 21st century has seen further modernization and industrial

Treatment burden as a predictor of self-management adherence within the primary care population

PurposeWe aimed to (1) describe the amount of treatment burden experienced in the primary care population diagnosed with chronic conditions and (2) examine if cumulative and task-specific treatment burden were predictors of medication, exercise, and dietary adherence in patients diagnosed with chronic conditions. DesignWe conducted a prospective, descriptive, cross-sectional study. MethodsWe enrolled 149 men and women from a single primary care clinic. Participants completed self-report surveys with data collected between September 2019 and December 2019. Our primary statistical analyses consisted of multivariate regression modeling. ResultsThe sample experience a moderate amount of treatment burden (M = 38.22; SD = 31.83). We found strong, negative correlations between both cumulative and task-specific burden in relation to medication, exercise, and dietary adherence (p < .001). Significant multivariate models (p < .001), controlling for sample demographics, demonstrated cumulative treatment burden predicted medication adherence, whereas task-specific burden predicted medication, exercise, and dietary adherence outcomes, with model effect sizes ranging from moderate (0.20) to large (0.54). ConclusionsResults demonstrate higher levels of cumulative and task-specific treatment burden predict medication, exercise, and dietary adherence within a sample diagnosed with various chronic conditions. These findings indicate the potential for using treatment burden screening in the clinical setting to identify individuals at risk for poor self-management adherence. Treatment burden screening also enables the provider to determine areas of high burden affecting self-management adherence in order to design an effective treatment plan using targeted interventions, resources, or education to reduce patient burden in order to improve adherence.

Diabetes-related nutrition knowledge and dietary adherence in patients with Type 2 diabetes mellitus: A mixed-methods exploratory study

Aim: The aim of the study is to gain insights into the relationship between diabetes-related nutrition knowledge (DRNK) and diet quality in Singapore. Methods: Forty-two participants were recruited from a tertiary hospital. DRNK and diet quality were ascertained with the DRNK questionnaire and Alternate Healthy Eating Index 2010, respectively. Twenty-one semi-structured interviews of perceived barriers and enablers to adherence to dietary guidelines were audio recorded, transcribed and analysed. Results: Participants had a poor mean percentage DRNK score of 39.7% (±17.7) and diet quality of 54.2% (±9.4). Pearson’s correlation tests revealed no correlation between DRNK and diet quality ( r –0.29; p=0.065) but suggest a moderate positive correlation between DRNK and psychosocial self-efficacy ( r 0.41; p=0.008). Thematic analysis revealed six barriers (obesogenic environment; lack of time; conflict between advice and personal values; stress from external sources; lack of personal motivation; gaps in DRNK) and four enablers (personal motivation to improve condition; fear of T2DM complications; sufficient DRNK; presence of social support) to adherence to dietary guidelines. Conclusion: DRNK may not correlate with adherence to dietary guidelines; multiple mediating factors are identified when translating DRNK to practice.

909 MODIFIED-ESD PLUS APC AND SUTURING FOR WEIGHT REGAIN TREATMENT

With the cumulative increase in the number of patients undergoing bariatric surgery, postoperative weight regain has become a considerable challenge. Mechanisms for weight regain are not fully understood and the process is likely multifactorial in many cases, including type of surgery, physical activity, psychiatric comorbidities, and patient dietary adherence. Additionally, post-surgical anatomy modification such as larger pouch size and dilation of the gastrojejunal anastomosis (GJA) have been shown to correlate with increased postoperative weight gain. Endoluminal revisions that reduce gastric pouch size and diameter of the GJA may offer an effective and less invasive management strategy for this population.

HUBUNGAN DUKUNGAN KELUARGA DENGAN KEPATUHAN DIET DIABETES PADA PASIEN DIABETES MELLITUS TIPE 2 DI WILAYAH PUSKESMAS LIMO DEPOK

Diabetes Mellitus (DM) is the metabolic and chronic diseases characterized by hyperglycemia resulting from a defect in the production of insulin, action of insulin or both. The prevalence of type 2 DM was increased rapidly including in Indonesia. In Depok City, 145 people lived with type 2 DM. One of the treatment for type 2 DM patient is Dietary Adherence. The effectiveness of the dietary adherence in patient with type 2 DM could be influenced by the family support. The aimed of the study was to identify the relationship between family support and dietary adherence in patient with type 2 DM at Limo Public Health Center, Depok. There were 60 patients with type 2 DM at Limo Public Health Center, Depok. A descriptive correlation with the cross sectional design was used. The Dietary Adherence Questionnaire and the Family Support Questionnaire were used to the data collection then chi-square was performed to analyzed the data. The results of the study revealed that there was a relationship between family support and dietary adherence in patients with type 2 DM at Limo Public Health Center, Depok (p<.05). The family support is one of the nursing intervention to improve the dietary adherence in patient with DM. Moreover, due to patients with type 2 DM were interacted with their family commonly therefore family support could be a motivation to improve the dietary adherence.

An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease

BackgroundDietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD.MethodsThe Web of Science and Scopus databases were searched using the search terms ‘adherence’ and ‘end stage kidney disease’. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence.ResultsMost of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence.ConclusionDietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.

Long-Term Adherence to Low-Sodium Diet in Patients With Heart Failure.

Although following a low-sodium diet (LSD) for heart failure (HF) has been recommended for decades, little is known about factors related to long-term patient adherence. The purposes of this study were to (a) compare sodium intake and factors affecting adherence in a long-term adherent group and in a non-adherent group and (b) examine predictors of membership in the long-term adherent group. Patients with HF ( N = 74) collected 24-hr urine samples and completed the Dietary Sodium Restriction Questionnaire and the Patient Health Questionnaire-9. Long-term adherence was determined using the Stage of Dietary Behavior Change Scale. The long-term adherent group had lower sodium intake (3,086 mg vs. 4,135 mg, p = .01) and perceived more benefits from LSD than the non-adherent group. Only positive attitudes toward LSD predicted membership in the long-term adherence group (odds ratio [OR] = 1.18, p = .005). Interventions focused on enhancing positive perceptions of the benefits of an LSD may improve long-term dietary adherence in patients with HF.

Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran

ObjectiveTo identify barriers to recommended dietary adherence in patients with type 2 diabetes. DesignObservational cross-sectional study. SampleOne hundred-forty six overweight/obese volunteers with type 2 diabetes, who had previously received dietary advice for at least one year, were recruited from two diabetes clinics in Tabriz, north-west of Iran. MeasurementsA 24-item questionnaire was designed to assess dietary barriers. The validity and reliability of the questionnaire were assessed by Content Validity Index, Content Validity Ratio and Cronbach's alpha, respectively. An exploratory factor analysis with principal component analysis extraction and varimax rotation was utilized in order to extract the underlying factors of dietary nonadherence. ResultsFactor analysis yielded seven barrier factors including: situational barriers/difficulty resisting temptation [percent variance=11.64%], stress-related eating disorder/cost [percent variance=9.11%], difficulty with meal and snack plans [percent variance=8.76%], confusion [percent variance=8.45%], work-related issues [percent variance=7.72%], small portion size [percent variance=6.87%] and lack of palatability/family support [percent variance=6.78%]. These factors explained about 59.4% of the total variance. ConclusionsOverall, patients with type 2 diabetes perceived some barriers to recommended dietary adherence. In dietary counseling, considering and addressing these barriers will likely be effective in increasing the dietary adherence for patients with type 2 diabetes in Iran.

Understanding the Associations Between Modifying Factors, Individual Health Beliefs, and Hemodialysis Patients' Adherence to a Low-Phosphorus Diet

Hyperphosphatemia in end-stage renal disease is associated with significant morbidity and mortality. Because phosphorus is not effectively dialyzed, dietary adherence remains a significant problem. Previous studies have examined the health belief model, but none have looked at stages of change and dietary adherence in patients undergoing hemodialysis (HD). Cross-sectional survey. Three dialysis centers in Columbus, Ohio, between August 2012 and March2013. English-speaking patients age 18 or older on HD without dementia or developmental delay. None. Associations between dietary adherence based on the Precaution Adoption Process Model (stages of change) and serum phosphorus levels via a conceptual model incorporating modifying factors and individual health beliefs. Ninety-five patients completed the survey; 59 (62%) endorsed adherence to a low-phosphorus diet and 32 (34%) had phosphorus values ≤5.5mg/dL. Modifying factors associated with diet adherence included nonminority status odds ratio (OR), 95%CI 8.99 (1.08-74.60), greater level of education OR 18.23 (1.62-205.00), better quality of life OR 9.28 (1.35-63.71), and time on dialysis OR 1.04 (1.01-1.07). Individual health beliefs associated with diet adherence included perceived benefits OR 3.18 (1.47-6.88) and self-efficacy OR 1.22 (1.09-1.38). Modifying factors associated with phosphorus control included: age OR 0.94 (0.90-0.99), minority status OR 0.11 (0.02-0.68), greater level of education OR 6.60 (1.41-31.04), knowledge about chronic kidney disease OR 1.48 (1.03-2.13), and time on dialysis OR 0.98 (0.96-0.99). Individual health beliefs associated with phosphorus control included self-efficacy OR 1.08 (1.01-1.16). HD clinicians and educators may obtain better results with dietary adherence and phosphorus control if they focus not only toward disease and dietary education but also on understanding modifying factors and individual health beliefs. Assessing where the patient is with regard to stages of change may assist health care providers in better matching interventions that build patients' self-efficacy.

Spousal overprotection is indirectly associated with poorer dietary adherence for patients with type 2 diabetes via diabetes distress when active engagement is low.

The current study sought to explore the indirect association of spousal overprotection on patient dietary adherence through the mechanism of diabetes distress and whether the link between overprotection and diabetes distress was moderated by spouse active engagement. Participants were 117 married couples in which one member had been diagnosed with type 2 diabetes and were recruited from a patient registry at a Midwestern (USA) medical centre. Data were gathered from spouses and patients through a self-report survey instrument. The research questions were answered with structural equation modelling using the latent moderated structural equations (LMS) approach and dyadic data analytic procedures. Overprotection was associated with reduced dietary adherence indirectly via increased diabetes distress only at low levels of active engagement. The proposed model also proved superior when compared to two plausible alternatives. These findings highlight the importance of understanding the nuanced associations among the different ways spouses cope with illness to achieve better diabetes outcomes and the mechanisms responsible for linking coping and dietary adherence. Statement of contribution What is already known on this subject? Spousal coping behaviour can influence dietary adherence among patients diagnosed with type 2 diabetes, positively and negatively. Spouses simultaneously engage in different ways of coping with partner illness, but little is known about the interactive nature of coping styles or possible mechanisms that might link coping with illness outcomes. What does this study add? Spousal overprotection is only associated with reduced patient dietary adherence when spouses are also engaging in low levels of active engagement. Diabetes distress is an important mechanism linking spousal coping with patient dietary adherence.

Adherence to Mediterranean Diet and Counseling in Arterial Hypertension

Nutritional guidelines in Arterial Hypertension (AH) are presently not sufficiently followed in Italy as elsewhere. Dietary adherence of patients can be a consequence of the different health professionals involved. Adherence to Mediterranean Diet and its Score (AMDS; range 0–55) is a tool used as a proxy for suggested guidelines in Italy.Methods630 AH out‐patients (F 334, M 296, age 61,9±11,9 years, BMI 27,8±5,4 Kg/m2 ) were studied. A dietary history, with 7‐days food recall records by Dietosystem Software, and AMDS were assessed.AH as a cardiovascular risk factor was explained to patients and dietary treatment prescribed. Difference between one year dietary changes were assessed comparing counseling results of Primary M.D.s, Specialist M.D.s (Cardiologist) and dietitians.ResultsSignificant one‐year AMDS changes were observed in each group.Greater AMDS change is observed in Dietitians' group: AMDS change from 27,60±8,77 to 37,20±4,52 (p &lt; 0.0001).Significant BMI changes are present in Primary M.D.s group (BMI from 28,35±4,43 to 26,75±3,18; p&lt;0.0001) and in Dietitian counseling group (BMI from 30,22±6,75 to 26,72±4,87;p&lt;0.0001).ConclusionThe need of a consistent professional counseling in AH is necessary due to the co‐existence of obesity and of the low adherence to suggested dietary guidelines.Beneficial changes can be achieved using Mediterranean Diet as a nutritional and friendly paradigm.

Depressive Symptoms and Dietary Nonadherence in Patients with End-Stage Renal Disease Receiving Hemodialysis: A Review of Quantitative Evidence

Patients with end-stage renal disease (ESRD) who receive hemodialysis have high rates of psychosocial distress and nonadherence to diet prescription. The purpose of this study was to examine the quantitative research evidence about the effect of depressive symptoms on dietary adherence. A systematic search of the literature using MEDLINE, CINAHL, PubMed, and PsycINFO databases was performed for quantitative research studies. Forty-four studies met inclusion criteria and were included in this review. Nearly all studies supported an association between depressive symptoms and dietary adherence in patients with ESRD. Depressive symptoms were associated with dietary nonadherence in patients with ESRD.

Commentary on "Depression and Anxiety Symptoms Are Associated With Reduced Dietary Adherence in Patients With Heart Failure Treated With an Implantable Cardioverter Defibrillator"

Sue Wingate, PhD, RN, CRNP Cardiology Nurse Practitioner, Kaiser Permanente Mid-Atlantic States, Silver Spring, Maryland. Corresponding author Sue Wingate, PhD, RN, CRNP, 12434 Galesville Dr, Gaithersburg, MD 20878 ([email protected]).

Situation Taxonomy and Behavioral Diagnosis Using Prospective Self-Monitoring Data: Application to Dietary Adherence in Patients with Type 1 Diabetes

The goals of this study were to create a taxonomy of problem situations for diet adherence in persons with insulin-dependent diabetes mellitus (Type 1 diabetes) and a behavioral diagnosis by grouping patients together who have similar adherence problems. In study one, 29 patients with Type 1 diabetes kept food diaries for 4 weeks. Adherence was assessed using eight behavioral measures: (1) compliance with a meal plan, (2) energy intake, (3) protein, (4) carbohydrates, (5) fat, (6) self-reported overeating, (7) self-reported undereating, and (8) ratings of impulsive eating. The occurrence of each behavior was quantified in a wide range of situational contexts including meal, social context, physical location, and mood. Cluster analysis of behaviors, situations, and behaviors-in-situations was used to create a hierarchical classification model consisting of five major categories of adherence problems: (1) compliance with meal plan, (2) undereating, (3) overeating, (4) impulsive eating, and (5) lifestyle differences. Within each category, situations were associated with everyday eating habits and special circumstances such as social events, and meals in restaurants. Grouping patients based on the similarity of their adherence problems resulted in five diagnostic groups: (1) emotional binge eaters, (2) restrained eaters, (3) unrestrained eaters, (4) undereaters, and (5) cyclical diet bingers. In study two, 28 subjects kept diaries during an intervention program designed to enhance dietary adherence. Study two results were similar to study one. Situation taxonomy and behavioral diagnosis are potentially useful ways to understand the intervention needs of those attempting maintaining dietary behavior changes.