Effectiveness of a Nutritional Education Intervention on Increasing Fruit and Vegetable Consumption in Adults with Type 2 Diabetes

Abstract

Background: The prevalence Type 2 Diabetes Mellitus (T2DM) has been increasing significantly in the United States over the past decade, and it is more important than ever for primary care providers, including family nurse practitioners, to provide effective diabetes self-management education (DSME) at the point of care. One of the most important aspects of diabetes management is the practice of a healthy diet, high in fruit and vegetable consumption. The Health Belief Model (HBM), which purports that a change in human behavior can be stimulated through the modifications of certain variables, was utilized as the theoretical framework for this Doctor of Nursing Practice (DNP) Project. Objective: The purpose of this DNP Project is to increase fruit and vegetable consumption in adult patients with T2DM who visit a family practice clinic in Green Valley, AZ, through an educational intervention based on the theoretical framework of the Health Belief Model (HBM). Design: One-group pre-test/post-test quality improvement project Setting: Green Valley Family Practice between September 3, 2018 and October 26, 2018. to evaluate the effectiveness of a focused nutritional education intervention on increasing fruit and vegetable consumption in patients with T2DM at a family practice in Green Valley, Arizona. Participants: 18 adult patients aged 40 and older with T2DM visiting the clinic for diabetes follow up visits during the first four weeks of the study period Measurements: Participants were surveyed with food frequency questionnaire (FFQ) questions drawn from the Behavioral Risk Factor Surveillance System (BRFSSQ) Questionnaire, four Likert scale type questions written by the project leader based on Health Belief Model variables, and one question written by the project leader regarding perceived improvement in blood sugar control, which was only measured in the post-survey. Results: Of the 21 original participants, 18 were retained for the follow-up survey and included in the final results. Four weeks following the intervention, average daily vegetable consumption increased by 50.7% increase and fruit consumption by 44.2%. There were also increases in HBM variables of perceived benefits and self-efficacy, and a decrease in perceived barriers. There was also an increase in the average perceived blood sugar control among participants four weeks following the intervention. Conclusion: The educational intervention was effective in increasing fruit and vegetable consumption in adults with T2DM and can be feasibly replicated in similar family practice clinics that see this patient population. While it remains critical for FNPs to recommend structured diabetes self-management education to all patients with T2DM, it is also effective to provide brief patient-centered nutritional education during primary care visits to help empower patients into improving diabetes control.