Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Understanding the nutrition care needs of patients newly diagnosed with type 2 diabetes: a need for open communication and patient-focussed consultations

Lauren Ball A C , Ruth Davmor A , Michael Leveritt B , Ben Desbrow A , Carolyn Ehrlich A and Wendy Chaboyer A
+ Author Affiliations
- Author Affiliations

A Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Qld, Australia.

B School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Qld, Australia.

C Corresponding author. Email: l.ball@griffith.edu.au

Australian Journal of Primary Health 22(5) 416-422 https://doi.org/10.1071/PY15063
Submitted: 28 April 2015  Accepted: 18 August 2015   Published: 5 October 2015

Abstract

Patients who are newly diagnosed with type 2 diabetes mellitus (T2DM) commonly attempt to modify their dietary intake after receiving nutrition care from primary health professionals. Yet, adherence to dietary recommendations is rarely sustained and factors influencing adherence are poorly understood. This study explored T2DM patients’ experiences of dietary change and their views on how primary health professionals can best support long-term maintenance of dietary change. A purposive sample of 10 individuals recently diagnosed with T2DM participated in three individual semi-structured qualitative telephone interviews: at baseline, then at 3 and 6 months after recruitment. Interview questions were modified from the initial interview in order to investigate emerging findings. A two-step data analysis process occurred through content analysis of individual interviews and meta-synthesis of findings over time. Participants initially made wide-ranging attempts to improve dietary behaviours, but most experienced negative emotions from the restraint required to maintain a healthy diet. Participants felt confused by the conflicting advice received from health professionals and other sources such as friends, family, internet and diabetes organisations. Participants frequently reported feeling rushed and not heard in consultations, resulting in limited ongoing engagement with primary healthcare services. These findings suggest that there is opportunity for primary health professionals to enhance the dietary support provided to patients by: acknowledging the challenges of sustained improvements in dietary intake; open communication; and investing in patient relationships through more patient-focussed consultations.

Additional keywords: chronic disease, general practice, primary care, nutrition therapy, nutritional management.


References

Australian Bureau of Statistics (ABS) (2012). Australian health survey: first results. Available from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.001main+features12011-12 [Verified 7 September 2015]

Australian Government (2013). ‘National primary health care strategic framework.’ (Commonwealth of Australia: Canberra)

Australian Institute of Health and Welfare (2007). Incidence and prevalence of chronic diseases. (Commonwealth of Australia: Canberra)

Ball L, Hughes R, Leveritt M (2013) A study of health professionals’ views of the effectiveness of nutrition care in general practice. Nutrition & Dietetics 70, 35–41.
A study of health professionals’ views of the effectiveness of nutrition care in general practice.Crossref | GoogleScholarGoogle Scholar |

Ball LE, Hughes R, Leveritt M (2010) Nutrition in general practice: role and workforce preparation expectations of medical educators. Australian Journal of Primary Health 16, 304–310.
Nutrition in general practice: role and workforce preparation expectations of medical educators.Crossref | GoogleScholarGoogle Scholar | 21138698PubMed |

Ball LE, Hughes R, Desbrow B, Leveritt M (2012) Patients’ perceptions of nutrition care received from general practitioners: focus on type 2 diabetes. Family Practice 29, 719–725.

Ball L, Desbrow B, Leveritt M (2014) An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals. Australian Journal of Primary Health 20, 113–120.
An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals.Crossref | GoogleScholarGoogle Scholar | 23428232PubMed |

Bowen M (1966) The use of family theory in clinical practice. Comprehensive Psychiatry 7, 345–374.
The use of family theory in clinical practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaF2s%2FktVGiug%3D%3D&md5=9cb57e7893363596bbf194b3f4352915CAS | 5922263PubMed |

Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS (2012) The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine 87, 1243–1249.
The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy.Crossref | GoogleScholarGoogle Scholar | 22836852PubMed |

Cash T., Desbrow B., Leveritt M., Ball L. (2014) Utilization and preference of nutrition information sources in Australia. Health Expectations
Utilization and preference of nutrition information sources in Australia.Crossref | GoogleScholarGoogle Scholar | 24798108PubMed |

Castro-Sánchez A, Avila-Ortiz M (2013) Changing dietary habits in persons living with type 2 diabetes. Journal of Nutrition Education and Behavior 45, 761–766.
Changing dietary habits in persons living with type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 23900064PubMed |

Coppell KJ, Kataoka M, Williams SM, Chisholm AW, Vorgers SM, Mann JI (2010) Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment: Lifestyle Over and Above Drugs in Diabetes (LOADD) study. British Medical Journal 341, c3337
Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment: Lifestyle Over and Above Drugs in Diabetes (LOADD) study.Crossref | GoogleScholarGoogle Scholar | 20647285PubMed |

Corr L, Rowe H, Fisher J (2015) Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions. Australian Journal of Primary Health 21, 58–65.
Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2c%2Fnt1CrsA%3D%3D&md5=6261614e8607c2ad10babf5577beb0afCAS | 24134820PubMed |

Diabetes Australia (2012). Diabetes in Australia. Available at www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia [Verified 7 September 2015]

Diabetes Australia, Royal Australian College of General Practitioners (RACGP). (2008). Diabetes management in general practice 14th edition. AIHW: Sydney.

Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24, 105–112.
Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c%2FmvVKquw%3D%3D&md5=8816b8cd3eff90ce3081f3ae02ad21d9CAS | 14769454PubMed |

Harris M, Kidd M, Snowdon T (2008). ‘New models of primary and community care to meet the challenges of chronic disease prevention and management: a discussion paper for NHHRC.’ (University of New South Wales: Sydney, NSW)

Hillson R (2014) Embarassing diabetes. Practical Diabetes 31, 313–314.
Embarassing diabetes.Crossref | GoogleScholarGoogle Scholar |

Histock J, Legard R, Snape D (2001). ‘Listening to diabetes service users: qualitative findings for the Diabetes National Service Framework.’ (Department of Health: London)

Holman H, Lorig K (2000) Patients as partners in managing chronic disease. British Medical Journal 320, 526–527.
Patients as partners in managing chronic disease.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ltlegsg%3D%3D&md5=a4edbe9a6cc857483f79f69585402007CAS | 10688539PubMed |

Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15, 1277–1288.
Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |

Kowitt S. D., Urlaub D., Guzman-Corrales L., Mayer M., Ballesteros J., Graffy J., Simmons D., Cummings D.M., Fisher E. B. (2015) Emotional support for diabetes management: an international cross-cultural study. Diabetes Educator
Emotional support for diabetes management: an international cross-cultural study.Crossref | GoogleScholarGoogle Scholar | 25722064PubMed |

Lawson PJ, Flocke SA (2009) Teachable moments for health behavior change: a concept analysis. Patient Education and Counseling 76, 25–30.
Teachable moments for health behavior change: a concept analysis.Crossref | GoogleScholarGoogle Scholar | 19110395PubMed |

Liamputtong P (2010). ‘Qualitative research methods’, 3rd ed. (Oxford University Press: South Melbourne, Vic.)

McMillan SS, Kendell E, Sav A, King M, Whitty J, Kelly F, Wheeler A (2013) Patient-centred approaches to health care: a systematic review of randomized controlled trials. Medical Care Research and Review 70, 567–596.
Patient-centred approaches to health care: a systematic review of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 23894060PubMed |

Murray P, Chune G, Raghavan V (2010) Legacy effects from DCCT and UKPDS: what they mean and implications for future diabetes trials. Current Atherosclerosis Reports 12, 432–439.
Legacy effects from DCCT and UKPDS: what they mean and implications for future diabetes trials.Crossref | GoogleScholarGoogle Scholar | 20652839PubMed |

National Health and Hospitals Reform Commission (2009). ‘A healthier future for all Australians: final report of the National Health and Hospitals Reform Commission.’ (Commonwealth of Australia: Canberra)

Sandelowski M, Barroso J (2007). ‘Handbook for synthesizing qualitative research.’ (Springer: New York)

Sequist TD, Von Glahn T, Li A, Rogers WH, Safran DG (2012) Measuring chronic care delivery: patient experiences and clinical performance. International Journal for Quality in Health Care 24, 206–213.
Measuring chronic care delivery: patient experiences and clinical performance.Crossref | GoogleScholarGoogle Scholar | 22490300PubMed |

Shrestha D, Joyce CM (2011) Aspects of work-life balance of Australian general practitioners: determinants and possible consequences. Australian Journal of Primary Health 17, 40–47.
Aspects of work-life balance of Australian general practitioners: determinants and possible consequences.Crossref | GoogleScholarGoogle Scholar | 21616023PubMed |

Spencer L, O’Shea MC, Ball L, Desbrow B, Leveritt M (2013) Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services. Australian Journal of Primary Health 20, 291–297.
Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services.Crossref | GoogleScholarGoogle Scholar |

Strauss A, Corbin J (2007) ‘Basics of qualitative research: techniques and procedures for developing grounded theory’, 3rd edn. (Sage: Newbury Park, CA)

Thomson R, Holland J (2003) Hindsight, foresight and insight: the challenges of longitudinal qualitative research. International Journal of Social Research Methodology 6, 233–244.
Hindsight, foresight and insight: the challenges of longitudinal qualitative research.Crossref | GoogleScholarGoogle Scholar |