A Mixed Methods Evaluation of a Randomized Control Trial to Evaluate the Effectiveness of the Pure Prairie Living Program in Type 2 Diabetes Participants

Effectiveness and Acceptability of a Nutrition Intervention Targeting Chinese Adult Immigrants With Type 2 Diabetes in Canada: A Study Using Mixed Methods Analysis

OBJECTIVES

Although culturally tailored diabetes treatment is recommended, there is a lack of relevant dietary resources for the Chinese population in Canada. In this study we assessed the feasibility and efficacy of a culturally tailored menu plan combined with nutrition education on clinical outcomes, diet quality and qualitative outcomes among Chinese immigrants with type 2 diabetes.

METHODS

Participants were 17 Chinese immigrants living with type 2 diabetes in Edmonton, Alberta, Canada. The design was a 12-week, single-arm intervention that included weekly nutrition education supported by a culturally tailored menu plan with mixed methods evaluation. Diet quality, clinical and other outcomes were assessed pre- and postintervention. One-on-one interviews were conducted postintervention to identify program feasibility and obstacles to adherence.

RESULTS

Waist circumference (mean ± standard deviation: -2.0±2.5 cm; p=0.004), total cholesterol (-21.4±28.2 mg/dL; p=0.007) and low-density lipoprotein cholesterol (-18.4±24.6 mg/dL; p=0.007) were decreased when compared with baseline. No significant change was detected in glycated hemoglobin. Postintervention, the Healthy Eating Index (p=0.01) and diabetes knowledge score (p=0.009) also increased. Participants reported that the program was culturally acceptable, easily understood and feasible to implement. Participants indicated the program helped them to improve their diabetes knowledge, adhere to the dietary guidelines, choose low glycemic index food and read food labels when shopping.

CONCLUSIONS

A flexible, culturally tailored menu plan was a feasible and effective tool for improving diabetes knowledge, diet quality and metabolic outcomes among Chinese immigrants with type 2 diabetes.

Contextually Appropriate Tools and Solutions to Facilitate Healthy Eating Identified by People with Type 2 Diabetes

Type 2 diabetes (T2D) is a complex, multifaceted disease and its treatment involves lifestyle intervention (LI) programs that participants may find difficult to adopt and maintain. The objective of this study is to understand the lived experiences of participants with T2D regarding healthy eating behavior change, in order to identify and incorporate relevant information, skills, and educational approaches into LI programs. An explorative qualitative study was undertaken. Purposeful sampling was used to recruit 15 participants. One-on-one, semi-structured, open-ended, and in-depth interviews were conducted. An essentialist paradigm was adopted to accurately report the experiences, meaning, and reality of participants. An inductive approach was used to analyze the data. Participants reported that being diagnosed and living with T2D could be overwhelming, and their ability to manage was influenced by health care providers (HCP), family, and individual context. Many experienced a loop of "good-bad" eating behaviors. Participants expressed desires for future diabetes management that would include program content (nutrition, physical activity, mental health, foot care, and consequences of T2D), program features (understand context, explicit information, individualized, hands-on learning, applicable, realistic, incremental, and practical), program components (access to multidisciplinary team, set goals, track progress and be held accountable, one-on-one sessions, group support, maintenance/follow-up), and policy change. In conclusion, the results of this study indicate that T2D management requires more extensive, comprehensive, and ongoing support, guided by the individual participant.