Development and Efficacy of an Electronic, Culturally Adapted Lifestyle Counseling Tool for Improving Diabetes-Related Dietary Knowledge: Randomized Controlled Trial Among Ethnic Minority Adults With Type 2 Diabetes Mellitus

Abstract

BackgroundEthnic minority populations exhibit disproportionately high rates of type 2 diabetes mellitus (T2DM). Electronic health tools have the potential to facilitate the cultural adaptation and tailoring of T2DM education to improve the knowledge and management of diabetes mellitus (DM).ObjectiveThis study aimed (1) to develop an adaptable Interactive Lifestyle Assessment, Counseling, and Education (I-ACE) software to support dietitian-delivered lifestyle counseling among low-socioeconomic status (SES) ethnic minority patients with T2DM and (2) to evaluate its effect on DM-related dietary knowledge and management compared with standard lifestyle advice (SLA) in a randomized controlled trial (RCT).MethodsThe I-ACE software, developed in consultation with clinical dieticians, incorporates evidence-based dietary and physical activity (PA) recommendations and educational materials. The features and behavioral change techniques include quantitative lifestyle (dietary intake and PA) assessment and simulation, individually tailored education and recommendations, motivational interviewing, and goal setting. For the unblinded pilot RCT, 50 overweight or obese Arab adults (aged 40-62 years) with poorly controlled T2DM were recruited from primary care clinics and randomly assigned to receive 4 in-person, dietician-delivered counseling sessions over 6 months using either (1) the I-ACE tool (experimental arm) or (2) the SLA methods (comparison arm). All outcome assessments were face-to-face. DM-related dietary knowledge (primary outcome) was measured at baseline, 3, 6, and 12 months. Lifestyle and other parameters were measured before, during, and after the intervention. Multiple linear regression and repeated measures linear mixed models were used to compare the changes in study outcomes and explore time trends in between-group and within-group changes.ResultsA total of 25 participants were enrolled in each arm, of whom 24 and 21 completed the final assessment of the primary outcome in the I-ACE and SLA arms, respectively. DM-related lifestyle knowledge increased more rapidly in the I-ACE arm than in the SLA arm (P value for study arm×time interaction=.02). Within the I-ACE arm, the mean (SE) differences in added sugar and dietary fiber intakes from baseline to 12 months were −2.6% (SE 1.0%) of total energy (P=.03) and 2.7 (SE 0.0) g/1000 kcal (P=.003), respectively. The odds of engaging in any leisure PA at 12 months tended to be higher in the I-ACE arm versus SLA arm, but did not reach statistical significance (odds ratio 2.8; 95% CI 0.7-11.6; P=.16). Both arms exhibited significant reductions in HbA1c (P value for change over time <.001).ConclusionsThe use of the I-ACE software in a 6-month, 4-session dietician-delivered lifestyle counseling intervention improved the efficiency of lifestyle education, compared with SLA, among low-SES, ethnic minority patients with T2DM. This pilot trial provides justification for conducting a large-scale trial to evaluate its effectiveness and applicability in routine clinical care amon...

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

“…Four mixed methods studies were rated ranging from 66% (10/15 items) to over 80% (13/15 items) [ 18 , 32 – 34 ]. The rest of the articles were rated 60% (3/5 items, n = 10) [ 20 , 35 – 43 ] or 80% (4/5 items, n = 12) [ 21 , 44 – 54 ]. The MMAT scores are presented in Table 2 and Additional file 1 .…”

“…Patients’ usability of eHealth was effective or positive in most articles (61.54%, n = 8/13) [ 34 , 35 , 38 , 39 , 44 , 46 , 52 , 54 ]. Four articles (30.77%) showed both satisfaction (e.g.…”

“…Eight articles (30.77%) illustrated ineffective outcomes (e.g. no significant increase in PA levels) [ 32 , 36 , 38 , 42 , 49 , 50 , 52 , 54 ].…”

Primary Health Care Providers’ Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study

“…[19][20][21][34][35][36][37][38][39] Numerous studies have explored PA as a stand-alone topic for counselling, 17,[19][20][21]34,37,[39][40][41][42] while others have explored counselling for combinations of PA and other health behaviors (eg nutrition, smoking, and alcohol use). 15,16,18,23,35,36,38,[43][44][45][46][47][48][49][50][51] Among these studies, the outcomes of using eHealth technologies for PA counselling in PHC settings were diverse. 52 This is reflective of the different needs across the wide range of PHC settings.…”

Social Media–Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial

“…mHealth technology has increasingly been integrated into health care to meet the demands of diabetic care during the COVID-19 pandemic. It has been shown to be effective at enhancing health outcomes, such as medication adherence, glycated hemoglobin (HbA 1c ) levels, and self-management [10][11][12][13][14][15][16][17][18]. Studies have shown that multimedia education using videos is more effective than written information in terms of engagement and information uptake [19,20].…”