Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting

Abstract

Objective:

The purpose of this study was to adapt a diabetes nutrition education programme (NEP) developed for a primary healthcare setting for implementation in a tertiary healthcare setting. This manuscript describes the processes and considerations that were made.

Methods:

Four key steps for adapting interventions identified from the literature were used. The steps included (i) assessing the needs and logic model of change, (ii) assessing the applicability of the NEP components to the new setting, (iii) making adaptations, and (iv) planning for implementation and evaluation. In the various steps, patients and health professionals were involved mainly using qualitative methods: needs assessment (n = 28 and n = 10), making adaptations (n = 10 and n = 10) respectively, and patients (n = 5) in step four.

Findings:

Knowledge, self-efficacy and outcome expectations were identified as the main behaviour determinants in tertiary patients; therefore, the adapted NEP retained social cognitive theory as its foundation. The adapted NEP included new behaviour change techniques, particularly self-monitoring (behaviour and outcome) and vicarious learning using testimonials of successful management. The adapted NEP retained the original NEP components except the vegetable gardening demonstration. By incorporating monthly, instead of weekly group training sessions, a session for setting individual goals, provision of a workbook and additional relevant information, the adapted NEP catered for the tertiary patients’ needs.

Conclusion:

The comprehensive adaptation process involved input from key stakeholders, which increases the chances of intervention effectiveness. The adapted NEP is being implemented through a randomised controlled trial and its evaluation will illuminate the impact of the changes made to the original NEP.

Keywords::

• adaptation
• diabetes self-management education
• type 2 diabetes
• nutrition education
• nutrition education programme

Acknowledgements

The authors gratefully acknowledge Deborah M. Kupolati for assisting in the focus-group discussions and Cheryl Tosh (University of Pretoria) for assisting with manuscript editing. They also thank the patients and health professionals who participated in the study. Marizanne Booyens and Mmatlhapi Mhlakaza of Creative Studios, Department for Education Innovation, University of Pretoria are thanked for the design and production of the education materials. Nestlé Nutrition Institute Africa is acknowledged for a previous scientific award to Jane Muchiri, which enabled the production of the education materials.

Disclosure statement

No potential conflict of interest was reported by the authors.

The Claude Leon Foundation is acknowledged for the postdoctoral fellowship support for Jane Muchiri.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.