Using health action process approach to determine diet adherence among patients with Type 2 diabetes

Abstract Background Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). Conclusion Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. Trial registration: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir

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Implementation of Health Action Process Approach to Improve Dietary Adherence in Type 2 Diabetic Patient

Jurnal NERS ◽

10.20473/jn.v10i22015.272-278 ◽

2016 ◽

Vol 10 (2) ◽

pp. 272

Author(s):

Kusnanto Kusnanto ◽

Iqlima Dwi Kurnia ◽

Dwi Indah Prasetia

Keyword(s):

Blood Sugar ◽

Self Efficacy ◽

Process Approach ◽

Diabetic Patients ◽

Dietary Adherence ◽

Health Action Process Approach ◽

Health Action ◽

Action Process ◽

Type 2 Diabetic

Introduction: Type 2 diabetic patients usually unsuccessful to follow the diet recommendation due to lack of motivation, memory and intention. This study attempts to increase the motivation and also to improve intention in dietary adherence through the implementation of Health Action Process Approach (HAPA). Method: This study was a quasy-experiment. The population were type 2 diabetic patients in Puskesmas Krian Sidoarjo in March-April 2015. Respondents were only 16 and had been divided into experiment and control group. The independent variable was the implementation of HAPA. The dependent variable were self-efficacy, dietary adherence and blood sugar levels. The instruments in this study were questionnaires and blood sugar monitoring devices. Data were analyzed using statistical wilcoxon sign rank test and mann whitney u test with significance level α ≤ 0.05. Result: Wilcoxon sign rank test showed there were differences between pre and post test significantly on self-efficacy (p=0.014), dietary adherence (p=0.025), blood sugar levels (p=0.009) in experiment group, while no significant differences in control group. Mann Witney U test showed that there was significant difference on dietary adherence (p=0.002) between two groups. Discussion: In conclusion, the implementation of HAPA can improve dietary adherence in type 2 diabetic patient. Further, following studies are expected with large number respondents and identify the whole variables in the HAPA theory.Keywords: Health Action Process Approach (HAPA), self efficacy, dietary adherence, blood glucose, Diabetes Mellitus (DM)

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