The Development of a Dietary Behavioral Modification Model for Persons with Type 2 Diabetes in Nakhon Ratchasima Province

Abstract

Type 2 diabetes is a major public health problem. Ineffective disease control resulting from inappropriate dietary behaviors can lead to severe multisystem complications. Therefore, knowledge and modification of dietary behaviors can help reduce the risk of complications in patients with type 2 diabetes. This research and development study aimed to create a dietary behavior modification model for patients with type 2 diabetes and to evaluate its effectiveness on the stages of behavior change, knowledge, and eating behavior. The study proceeded in three phases: situational analysis, model design and development, and pilot testing and evaluation. Participants were patients with uncontrolled blood glucose and family meal managers; simple random sampling was applied to recruit individuals in the Contemplation or Preparation stages. Instruments included assessment tools for stage-of-change, knowledge, and dietary behavior. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and the Mann–Whitney U test.

The results from Phase 1 found that over half of the patients demonstrated good nutrition knowledge, whereas most exhibited moderate eating behaviors and remained in the Contemplation stage; dietary habits, attitudes toward diabetes, and household income influenced their readiness to change. In Phase 2, a Transtheoretical-based model (TTM-based model) comprising 13 activities over 5 weeks yielded statistically significant improvements in stage-of-change, knowledge, and eating behavior (p < .001), though time and activity formats limited participant understanding and engagement. Accordingly, in Phase 3, the format was revised to an 8-week program consisting of 14 activities, with additional content and methods and a reordering of the activities. Consequently, the intervention group in this phase showed statistical significantly greater improvements in the stage of behavior change, knowledge, and dietary behavior compared with baseline and the control group
(p < 0.001).

The findings indicate that the developed model effectively enhances knowledge and modifies eating behavior in patients with type 2 diabetes. Therefore, it should be implemented to control the disease and reduce the risk of complications.