Aim: The aim of the study is to gain insights into the relationship between diabetes-related nutrition knowledge (DRNK) and diet quality in Singapore. Methods: Forty-two participants were recruited from a tertiary hospital. DRNK and diet quality were ascertained with the DRNK questionnaire and Alternate Healthy Eating Index 2010, respectively. Twenty-one semi-structured interviews of perceived barriers and enablers to adherence to dietary guidelines were audio recorded, transcribed and analysed. Results: Participants had a poor mean percentage DRNK score of 39.7% (±17.7) and diet quality of 54.2% (±9.4). Pearson’s correlation tests revealed no correlation between DRNK and diet quality ( r –0.29; p=0.065) but suggest a moderate positive correlation between DRNK and psychosocial self-efficacy ( r 0.41; p=0.008). Thematic analysis revealed six barriers (obesogenic environment; lack of time; conflict between advice and personal values; stress from external sources; lack of personal motivation; gaps in DRNK) and four enablers (personal motivation to improve condition; fear of T2DM complications; sufficient DRNK; presence of social support) to adherence to dietary guidelines. Conclusion: DRNK may not correlate with adherence to dietary guidelines; multiple mediating factors are identified when translating DRNK to practice.
Aim Diabetes‐related nutrition knowledge (DRNK) is essential for the self‐care of patients with type 2 diabetes mellitus (T2DM). A specific tool measuring DRNK can help us to understand awareness levels and tailor structured nutrition education programs. Our study aimed to develop a questionnaire to assess DRNK for individuals with T2DM in Singapore. Methods An expert panel was formed to consolidate in‐depth, culturally suitable, and current information on DRNK. A literature review of diabetes self‐care knowledge questionnaires was performed to outline the scope of the questionnaire and generate a question pool. User friendliness was tested in the first draft of the questionnaire (n = 21). Then, a second draft was tested for item difficulty, discrimination index, and internal consistency (n = 62). The final draft was examined for construct validity and test–retest reliability (n = 100). Results The final questionnaire (four sections: 27 questions) was found to be consistent and reliable. The item difficulty scores of the selected questions ranged from difficult to desirable (2–85). There was fair to good internal consistency (Cronbach's alpha: 0.66, 0.79, 0.56, and 0.78 for Sections 1, 2, 3 and 4, respectively) and construct validity (independent t‐test: P < 0.001). Questions in the final questionnaire had an average discrimination index of 0.3 (reasonably good). The questionnaire was revealed to have good test–retest reliability (intraclass correlation: 0.82–0.84). Conclusions The DRNK questionnaire is a valid and reliable measure to complement assessment tools measuring self‐efficacy/behaviour in individuals with T2DM living in Singapore.
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