Saengrut Bumnet, Panuthai Sirirat, Chintanawat Rojanee, Suwankruhasn Nattaya
Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
Belitung Nurs J. 2024 Oct 14;10(5):498-508. doi: 10.33546/bnj.3482. eCollection 2024.
Uncontrolled type 2 diabetes mellitus (T2DM) is a prevalent issue among older adults. Healthy eating behavior (HEB) is a significant factor contributing to blood sugar control. It is a complex behavior that requires knowledge, attitudes, and skills in food literacy, which can be achieved through collaborative learning by nurses. Although collaborative learning has successfully improved food literacy and HEB among adults and older adults in general, its effectiveness has not been investigated among older adults with uncontrolled T2DM.
This randomized controlled trial aimed to examine the effects of the Collaborative Learning-Based Food Literacy Enhancement Program (CLFLEP) on HEB and hemoglobin A1c (HbA1c) levels among older adults with uncontrolled T2DM.
Participants were 80 older adults with uncontrolled T2DM attending primary care units (PCUs) or sub-district health promotion hospitals in northern Thailand. They were randomly assigned to either the experimental group ( = 40) or the control group ( = 40). The experimental group received the CLFLEP to enhance four domains of food literacy through five major elements of collaborative learning, while the control group received standard care. Data were collected between January and June 2023 using the Demographic Data Form, the Eating Behavior Questionnaire, the HbA1c test, and the Short Food Literacy Questionnaire. Data analysis involved descriptive statistics for demographic characteristics and independent -test and paired sample -test for HEB and HbA1c based on intention-to-treat (ITT) and per-protocol (PP) analyses.
The experimental group had a higher HEB score than the control group ( <0.001 for ITT and PP) and higher than their scores before program participation ( <0.001 for ITT and PP). The effect size (Cohen's ) was 1.46. The experimental group also had a lower HbA1c level than the control group ( = 0.002 for ITT and PP) and lower than their levels before program participation ( = 0.005 for ITT and 0.001 for PP). The effect size (Cohen's ) was 0.70.
The CLFLEP was effective in promoting food literacy, HEB, and blood sugar control. Nurses can be trained to use this program to provide collaborative health education for older adults with uncontrolled T2DM. Nursing administrators can use these findings to develop organizational policies that enhance nurses' competencies as educators skilled in collaborative learning.
TCTR20221222005 [Thai Clinical Trials Registry].
未得到有效控制的2型糖尿病（T2DM）在老年人中是一个普遍存在的问题。健康的饮食行为（HEB）是有助于血糖控制的一个重要因素。它是一种复杂的行为，需要具备食物素养方面的知识、态度和技能，而这可以通过护士的协作学习来实现。尽管协作学习总体上已成功提高了成年人和老年人的食物素养及健康饮食行为，但在未得到有效控制的T2DM老年患者中，其有效性尚未得到研究。
这项随机对照试验旨在研究基于协作学习的食物素养提升项目（CLFLEP）对未得到有效控制的T2DM老年患者的健康饮食行为和糖化血红蛋白（HbA1c）水平的影响。
研究对象为80名在泰国北部基层医疗单位（PCUs）或社区健康促进医院就诊的未得到有效控制的T2DM老年患者。他们被随机分为实验组（n = 40）和对照组（n = 40）。实验组接受CLFLEP，通过协作学习的五个主要要素来提高食物素养的四个领域，而对照组接受标准护理。在2023年1月至6月期间，使用人口统计学数据表、饮食行为问卷、HbA1c检测和简短食物素养问卷收集数据。数据分析包括对人口统计学特征的描述性统计，以及基于意向性分析（ITT）和符合方案分析（PP）对健康饮食行为和HbA1c进行独立样本t检验和配对样本t检验。
实验组的健康饮食行为得分高于对照组（ITT和PP分析中P均<0.001），且高于项目参与前的得分（ITT和PP分析中P均<0.001）。效应量（科恩d值）为1.46。实验组的HbA1c水平也低于对照组（ITT分析中P = 0.002，PP分析中P = 0.002），且低于项目参与前的水平（ITT分析中P = 0.005，PP分析中P = 0.001）。效应量（科恩d值）为0.70。
CLFLEP在促进食物素养、健康饮食行为和血糖控制方面是有效的。护士可以接受培训以使用该项目为未得到有效控制的T2DM老年患者提供协作式健康教育。护理管理人员可以利用这些研究结果制定组织政策，以提高护士作为协作学习教育者的能力。
TCTR20221222005 [泰国临床试验注册中心]
