Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes

Self-reported barriers in self-management of women with gestational diabetes: A systematic review of qualitative studies

AIM

To provide a systematic review of the qualitative literature on self-reported barriers to self-management in pregnant women with gestational diabetes mellitus (GDM).

DESIGN

Systematic review.

METHODS

This systematic review followed the Joanna Briggs Institute meta-aggregation approach and was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative studies on the barriers to self-management among GDM pregnancy survivors conducted until 17 May 2022, were searched.

RESULTS

A total of 30 studies were included, of which seven were in Chinese and 23 were in English, and 10 findings resulted in three themes: (a) Knowledge and belief, (b) Skills and abilities and (c) Environment and social support. By summarizing the self-reported barriers to self-management in patients with GDM and recommends precise interventions for these barriers, thereby saving health resources and helping to increase their willingness and ability to engage in self-management.

Intention to adopt a healthy diet among women with and without a history of gestational diabetes: Constructs and beliefs from the theory of planned behavior

Women with a history of gestational diabetes (GDM) have difficulty maintaining a healthy diet after delivery. The theory of planned behavior (TPB) is effective in identifying the determinants of adopting a healthy diet. The objectives were to identify the determinants of the intention to adopt a healthy diet among the TPB constructs in women with (GDM+) and without (GDM-) a history of GDM, and to identify the beliefs associated with these constructs. The study was conducted in Québec (Canada) between 2009 and 2017. Data from 213 GDM+ and 91 GDM- women were analyzed. Women completed a questionnaire on the determinants of intention to adopt a healthy diet, defined as adherence to 2007 Canada's Food Guide. The subjective norm and perceived behavioral control (PBC) constructs were associated with the intention to adopt a healthy diet among GDM+ women (β = 2.21 and β = 4.37, respectively, p < 0.0001), whereas among GDM- women, PBC was the only construct associated with intention (β = 0.78; p < 0.0001). More specifically among GDM+ women, the disapproval of a family member other than the partner (β = 1.49; p = 0.0005), not feeling capable of adopting a healthy diet with access to food treats (β = 1.58; p < 0.0001), lack of free time (β = 1.31; p = 0.002), lack of information about healthy eating (β = 1.02; p = 0.015) or lack of easy recipes to prepare (β = 0.84; p = 0.042) was associated with a lower intention to adopt a healthy diet. Overall, among GDM+ women, different beliefs related to the subjective norm and PBC could be targeted to improve the eating habits of this specific population.

Translation and psychometric testing of the simplified version of the health-related diet and exercise self-efficacy scale in China

Background

Measuring health-related diet and exercise self-efficacy is an important first step in improving healthy behaviors and health outcomes. However, we did not find a self-efficacy measurement in Chinese that is specifically targeted at diet and exercise self-efficacy among healthy adults.

Aim

The present study aimed to translate the Health-Related Diet and Exercise Self-Efficacy Scale -simplified version into Mandarin Chinese (HRDESES) and evaluate its reliability and validity in Chinese healthy adults.

Methods

The HRDESES was translated and adapted to the Chinese context, with a good content validity of 0.86 among seven experts. The survey was then carried out in 216 adults in Hunan, China. Testing of the reliability included internal consistency reliability and test-retest reliability, while validity included content validity, construct validity, and criterion validity.

Results

The Cronbach's α of the HRDESES was 0.87 for the total scale, 0.86 for the diet subscale and 0.91 for the exercise subscale; the McDonald's ω of the HRDESES-SC was 0.85 for the total scale, 0.86 for the diet subscale and 0.91 for the exercise subscale, all demonstrating good internal consistency. The test-retest reliability was 0.88 for the total scale, 0.81 for the diet subscale and 0.82 for the exercise subscale, demonstrating good test-retest reliability. For construct validity, the scale effectively distinguished subjects by age, gender, education, occupation, marital status, and family income, showing good discriminant validity. The confirmatory factor analysis (CFA) supported a two-factor structure of the scale: diet and exercise subscale. It was demonstrated that the HRDESES was highly associated with the General Self-Efficacy Scale and its two subscales, with correlation coefficients ranging from 0.83 to 0.86 (p < 0.05), showing high criterion validity.

Conclusion

The HRDESES had good reliability and validity and could be used as a simple and effective tool for assessing the health-related diet and exercise self-efficacy in Chinese healthy adults.

The prevention of gestational diabetes mellitus (The role of lifestyle): a meta-analysis

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy. The disease is on the rise worldwide with deleterious consequences on the fetus, mother, and children. The study aimed to review the role of lifestyle in the prevention of GDM. We searched PubMed, SCOPUS, Web of Science, Cochrane Library, EBSCO, and Google Scholar from the first published article up to December 2021; articles were eligible if they were controlled trials, prospective cohorts, and case-control. Out of 5559 articles retrieved, 66 full texts were screened, and 19 studies were included in the meta-analysis. (6 studies assessed the effects of diet, and 13 were on exercise). The dietary intervention showed significant positive effect on GDM, odd ratio = 0.69, 95% CI, 0.56-84, P-value for overall effect = 0.002. The DASH diet was better than Mediterranean Diet (odd ratio, 0.71, 95% CI, 68-74, P-value < 0.001). Regarding exercise, no significant prevention was evident on GDM, odd ratio, 0.77, 95% CI, 0.55-1.06, P-value = 0.11. However, a significant prevention of gestational diabetes was found when the exercise was mild-moderate (odd ratio = 0.65, 95% CI, 0.53-80, P < 0.0001) and started in the first trimester (odd ratio, 0.57, 95% CI, 0.43-0.75, P < 0.0001. No significant effect was found when the exercise was vigorous (odd ratio = 1.09, 95% CI, 0.50-2.38, P = 0.83) and started during the second trimester of pregnancy (odd ratio, 1.08, 95% CI, 0.65-1.80, P = 0.77. Diet and early mild-moderate exercise were effective in GDM prevention. Exercise during the second trimester and moderate-vigorous were not. Further studies assessing the type, duration, and frequency of physical activity are needed.

Discriminating Low to High Adherent Type 2 Patients with Diabetes by Glycosylated Hemoglobin A1c, Eating Self-Efficacy and Other Psychosocial Determinants: Difference Between Patient and Physician Adherence Models

OBJECTIVE

Develop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence.

METHODS

This was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited.

RESULTS

We found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models.

CONCLUSION

This research confirmed that patients and physicians perceived and judged patients' adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Significant Relationships Exist between Perceived and Objective Diet Quality in Young Adults

BACKGROUND

There is a disproportionate burden of low diet quality among young adults compared with other adult subpopulations that is not understood. Perceived and objective diet qualities are studied to understand possible barriers to change.

OBJECTIVE

To explore the association between perceived diet quality and objective diet quality in young adults in the United States.

DESIGN

This cross-sectional study used data from the 2013-2014 National Health and Nutrition Examination Survey to calculate total Healthy Eating Index-2010 (HEI-2010) score and component scores and study their relationships with perceived diet quality scores.

PARTICIPANTS/SETTING

The sample consisted of 1,261 young adults, aged 18 to 30, with 24-hour recall data.

MAIN OUTCOME MEASURES

Perceived and objective diet quality were evaluated.

STATISTICAL ANALYSES PERFORMED

Multiple regression analysis was used to test the ability to predict total HEI-2010 scores from perceived diet quality scores. Ordered logit was used to test whether HEI-2010 component scores predicted the odds of having higher perceived diet quality.

RESULTS

Excellent (b=8.442, P<0.001), very good (b=9.733, P<0.001), and good (b=5.527, P<0.001) perceived diet quality were significant predictors of total HEI-2010 score, compared with the referent category of poor perceived diet quality. The full regression model predicted 17.0% of the variance in total HEI-2010 score. Whole fruit (odds ratio [OR]=1.098, P=.017), whole grains (OR=1.046, P=.023), and empty calories (OR=1.054, P<0.001) were each significantly associated with the odds of having a higher rating of perceived diet quality (fair, good, very good, excellent) instead of a poor rating of diet quality; the difference in odds was low across categories.

CONCLUSIONS

There are significant relationships between perceived and objective diet quality, but other variables play a substantial role in explaining these two types of diet quality.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Compliance, illiteracy and low-protein diet: multiple challenges in CKD and a case of self-empowerment

BACKGROUND

Low-protein diets (LPD) are an important means of delaying the need for dialysis and attaining a stable metabolic balance in chronic kidney disease (CKD). Many authors consider a low educational level and illiteracy to be adverse features for a good dietary compliance.

CASE PRESENTATION

We report the case of a 77-year old woman, illiterate, affected by advanced CKD (stage 4 according to KDIGO guidelines). She was initially ashamed of her problem and did not declare it, leading to an overzealous reduction in protein intake. However, with her daughter's help, who translated the dietary prescription into images, she overcame the barrier represented by illiteracy and was able to correctly follow the prescriptions, attaining good kidney function stability and preserving an adequate nutritional status.

CONCLUSIONS

The case underlines the importance of a personalized approach to dietary prescriptions and suggests that it is possible to achieve a good compliance to the dietary treatment of CKD also in patients with relevant cultural barriers.

A process evaluation of the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial

Background

Supermarket Healthy Eating for Life (SHELf) was a randomized controlled trial that operationalized a socioecological approach to population-level dietary behaviour change in a real-world supermarket setting. SHELf tested the impact of individual (skill-building), environmental (20 % price reductions), and combined (skill-building + 20 % price reductions) interventions on women’s purchasing and consumption of fruits, vegetables, low-calorie carbonated beverages and water. This process evaluation investigated the reach, effectiveness, implementation, and maintenance of the SHELf interventions.

Methods

RE-AIM provided a conceptual framework to examine the processes underlying the impact of the interventions using data from participant surveys and objective sales data collected at baseline, post-intervention (3 months) and 6-months post-intervention. Fisher’s exact, χ² and t-tests assessed differences in quantitative survey responses among groups. Adjusted linear regression examined the impact of self-reported intervention dose on food purchasing and consumption outcomes. Thematic analysis identified key themes within qualitative survey responses.

Results

Reach of the SHELf interventions to disadvantaged groups, and beyond study participants themselves, was moderate. Just over one-third of intervention participants indicated that the interventions were effective in changing the way they bought, cooked or consumed food (p < 0.001 compared to control), with no differences among intervention groups. Improvements in purchasing and consumption outcomes were greatest among those who received a higher intervention dose. Most notably, participants who said they accessed price reductions on fruits and vegetables purchased (519 g/week) and consumed (0.5 servings/day) more vegetables. The majority of participants said they accessed (82 %) and appreciated discounts on fruits and vegetables, while there was limited use (40 %) and appreciation of discounts on low-calorie carbonated beverages and water. Overall reported satisfaction with, use, and impact of the skill-building resources was moderate. Maintenance of newly acquired behaviours was limited, with less than half of participants making changes or using study-provided resources during the 6-month post-intervention period.

Conclusions

SHELf’s reach and perceived effectiveness were moderate. The interventions were more effective among those reporting greater engagement with them (an implementation-related construct). Maintenance of newly acquired behaviours proved challenging.

Trial registration

Current controlled trials ISRCTN39432901.