An Evaluation of the Idaho Plate Method for Adults with Type 2 Diabetes and Limited Health Literacy in Rural West Virginia

Abstract

This capstone project evaluated the Idaho Plate Method (IPM) as an effective nutrition self-management program for adults with type 2 diabetes mellitus (T2DM) with limited health literacy (LHL) in one rural clinic in West Virginia. A one-way pretest-posttest design was used to evaluate the effects of the program on food choices, confidence, and HbA1c. A convenience sample of 30 volunteers participated in the program with 3-month follow-up data collected on 22 volunteers. A Wilcoxon test was conducted to evaluate choices of fruits, vegetables, and fatty foods and participant confidence in making healthful food choices. Data analysis found significant differences in fruit intake (z =-1.98, p 0.05); vegetables intake (z =-2.58, p .01); and skim milk intake (z =-2.094, p .04). There was a decrease intake of French-fries and fried potatoes (z =-2.26, p .02); butter or margarine on bread or pancakes (z =-2.494, p .01); regular fat hot dogs (z =-2.693, p<0.01); and total fat consumption (z =-2.50, p .01). A significant increase in confidence was found in participants ability to prepare or share food with nondiabetics (z =-3.10, p .002); to choose appropriate foods when hungry (z =-2.72, p = .006); to eat smaller portions at dinner (z =-2.46, p.014); and to add less fat than a recipe calls for (z =-2.10, p.035). Paired t-test analysis compared pretest-posttest HbA1c results with a very nearly significant difference between the HbA1c pretest (M = 7.96, SD = 1.83) and posttest (M = 7.34, SD = 1.60), t (24) = 2.02, p.055). Limitations of the study included the study design, lack of participants with LHL, high attrition rate, and study time restraints. Conclusions found, despite limitations, adults in rural WV with T2DM increased confidence in making healthy food choices, choosing healthy foods, and improving their glycemic control using the IPM. iii DEDICATION This author dedicates this Doctoral Capstone project to my family and friends. To my parents, Edward and Martha, who have always encouraged me to do my best in whatever I chose to do. Even though I lost my father during this journey, his spirit remains with me. To my children, Cyndi, Jamie, Nathan, and Randy, who have provided me with their love and support, and have repeatedly told me how proud they are of me. To my grandchildren, Joseph, Tucker, Jake, and Kyndall, who have given me permission to take a break and laugh when I needed it most. To my husband, James, who has shared this journey with me from the beginning; always listening; reminding me why I wanted to complete my DNP; and loving me despite everything. I must also thank a group of loved ones who never saw this day come to fruition, because they are counted in the statistics of those lost in the battle with diabetes-Grandma Ray, Peggie, Grandma and Grandpa Greer, Aunt Ruth, and Aunt Betty. Finally, I must thank my Lord and Savior Jesus Christ and my church family. Had it not been for my faith I would not have finished this journey. Hyperglycemia is cytotoxic to pancreatic beta cells (Weir et al., 2008). Co...

The Use of Portion Control Plates to Promote Healthy Eating and Diet-Related Outcomes: A Scoping Review

“…A total of 23 intervention studies were identified from the 22 peer-reviewed articles. Nine were randomised controlled trials (RCTs) (two with low [41,42] and seven with high risk of bias [43][44][45][46][47][48]), seven were quasi-experimental studies (three with low [49][50][51] and four with high risk of bias [52][53][54][55]), five were cross-sectional studies (one with low [56] and four with high risk of bias [57][58][59][60]), and two were qualitative studies with a high risk of bias [61,62].…”

“…Of the 23 intervention studies, 16 studies were conducted with adults [41][42][43][44]46,[48][49][50]52,53,56,[58][59][60][61] and 7 were conducted with children and adolescents [45,47,51,54,55,57,62]. The effect of the portion control plate was examined using 2D plate diagrams (n = 12) [44,49,50,52,53,[55][56][57][58][59][60]62] and using 3D portion plates (n = 11) [41][42][43][45][46][47][48]51,54,61]. An overview of eight types of portion control plates found in the grey literature is provided in Table 4.…”

“…Based on the JBI Critical Appraisal checklists, 6 studies were rated as low risk of bias [41,42,[49][50][51]56] and 17 studies were rated as high risk of bias [43,[45][46][47][48][52][53][54][55][57][58][59][60][61][62]. Most of the studies reviewed met the criteria relating to reliable outcome measurements, as well as appropriate intervention design and statistical analysis.…”

“…All six interventions which targeted adults with obesity or T2DM incorporated additional accompanying materials to the portion control plate (Table 3) [41][42][43]48,53,61]. Lifestyle advisors [61], dietitians [42], and tele-coaching [41] were used to support participants with the use of the portion control plate.…”

“…This set included a guided calibrated bowl and glass in addition to the plate. Furthermore, the Idaho plate method (IPM) nutrition program included teaching materials with a teacher's kit and PowerPoint compact disc in addition to the placemat with the portion plate model illustrated on it [53].…”