An individualised, rather than universal approach is needed for effective diabetes prevention, a new study has revealed.
The University of Otago's Associate Professor Kirsten Coppell was co-author of the collaborative study which aimed to understand the motivators, facilitators and challenges to dietary change among a diverse sample of New Zealanders with pre-diabetes.
The sample included 58 people aged 28 to 69, with similar numbers of men and women, indigenous Māori and non-Māori, and those who had and had not reverted to normal glucose metabolism at six months.
The study involved face-to-face interviews with a sample of adults with prediabetes and a body mass index greater than the “healthy” 25kg/m2, who were already taking part in a two-year primary care-based Prediabetes Dietary intervention programme, between 2018 and 2020.
Based in the Hawkes Bay, the intervention programme was designed to be a pragmatic primary care nurse-delivered approach to dietary advice for overweight and obese patients that could be adapted to each individual's circumstances.
It consisted of six components; primary care nurse training and support from a dietician, individualised advice and planning, key messages and consistent reminders, nutritionally supportive primary care environment, community-based group education for participants and their whānau, and written patient resources.
Overall, the study found while there are some clear themes, there is no one motivator, facilitator or challenge faced by patients wanting to make dietary changes.
“Influences on dietary change are not necessarily simple and involve personal, interpersonal, organisational, environmental and policy factors,” Associate Professor Coppell says.
“Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and be tailored accordingly within the context of the wider obesogenic and social-economic environment.”
A fear of getting type 2 diabetes was the strongest motivator for wanting to making dietary changes, followed by wanting to be healthy for whānau.
“Many wanted to take charge of their own health, mustering their will and determination to start making healthful dietary changes.”
Some aged over 55 realised they were no longer “bullet proof” and needed to act to stay healthy, and two Māori men were moved to act by the absence of older healthy Māori men in their community, she says.
“A common reason was wanting to enter old age in a healthy state and be around for close family members especially grandchildren, stating 'so that they can probably remember who I am'.”
Encouragement was also a strong motivator.
“Mostly encouragement was provided by a spouse, or partner, adult children or workmate, but another important motivator was the encouragement of their primary care nurse to go on the PIP programme.”
Reasons for adopting and sticking to changes in diet were similar; patients wanted to be healthy for themselves and for others, a personal determination – or as one participant described it, “a pig-headed resolve” – and feeling supported all helped them adhere to the programme.
However, the challenges were just as varied. Financial constraints, having other health conditions, attending social occasions, a lack of support from others in the household, and being overly busy and feeling stressed all challenged patients' ability to adopt and maintain dietary change.
“When talking about the challenges they faced, many people went on to describe strategies they had developed to work with or minimise the negative impacts,” Associate Professor Coppell says.
“Developing their own strategies empowered them and they felt proud of themselves for taking such control.”
The range of motivators and challenges discovered in the study shows it is important that diabetes prevention programmes consider the wider context of the obesogenic and socioeconomic environment and the influences and challenges this presents across sociocultural groups.
“The commonality of experience across the sample does not call for a universal approach to diabetes prevention efforts, but rather the identification of the specific ways these motivators, facilitators and barriers arise in, and are part of, people's lives,” she says.
The paper, published this month in the Public Health Nutrition journal was written by Associate Professor Coppell, of Kaupapa Consulting Ltd, Dr Sally Abel, of Kaupapa Consulting Ltd, Professor David Tipene-Leach, of the Eastern Institute of Technology and Professor Lisa Whitehead of Edith Cowan University, Australia.
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