تأثیر آموزش تغذیه بر اساس مدل BASNEF بر رفتارهای تغذیه‌ای و شاخص‌های کنترل قند خون بیماران سالمند مبتلا به دیابت نوع 2

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 کارشناس ارشد آموزش بهداشت، گروه آموزش بهداشت و ارتقای سلامت، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استاد، آموزش بهداشت و ارتقای سلامت، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 مربی، گروه آمار و اپیدمیولوژی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشیار، مرکز تحقیقات امنیت غذایی و گروه تغذیه‌ی جامعه، دانشکده‌ی تغذیه و علوم غذایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: مطالعه‌ی حاضر با هدف بررسی اثربخشی مدل BASNEF (باور‌ها، نگرش‌ها، هنجار‌های انتزاعی و عوامل قادر کننده) در آموزش تغذیه به سالمندان (≥ 60 سال) مبتلا به دیابت نوع 2 انجام پذیرفت.روش‌ها: در این مطالعه 100 نفر سالمند دیابتی به صورت تصادفی در دو گروه مداخله و شاهد تقسیم شدند. اطلاعات هر دو گروه به صورت مشابه و در دو زمان قبل و 3 ماه پس از مداخله‌ی آموزشی جمع‌آوری گردید. مداخله‌ی آموزش تغذیه در گروه مداخله بر اساس نیازسنجی اولیه و سازه‌های مدل BASNEF انجام شد و نتایج به وسیله‌ی آزمون‌های 2χ، Student-t و Paired-t مورد تجزیه و تحلیل قرار گرفت.یافته‌ها: میانگین نمره‌ی آگاهی و متغیرهای اجزای مدل BASNEF در گروه مداخله بهبود معنی‌داری نشان ‌داد (001/0 > P). علاوه بر آن، مقایسه‌ی رفتارهای تغذیه‌ای 3 ماه پس از مداخله‌ی آموزشی نیز حاکی از بهبود معنی‌دار در گروه مداخله بود. میانگین سهم روزانه‌ی دریافت گروه غذایی میوه و سبزیجات در گروه مداخله‌ افزایش یافت (001/0 > P). مقایسه‌ی میزان قند خون ناشتا و هموگلوبین گلیکوزیله در گروه مداخله کاهش معنی‌داری را (به ترتیب 5/19 میلی‌گرم در دسی‌لیتر و 36/0 درصد) نشان داد.نتیجه‌گیری: مداخله‌ی آموزش تغذیه بر اساس مدل BASNEF علاوه بر بهبود آگاهی و نگرش سالمندان مبتلا به دیابت نوع 2، سبب بهبود رفتار‌های تغذیه‌ای آنان نیز شد که ‌این امر در مدت 3 ماهه‌ی مداخله‌ی آموزشی موجب بهبود در شاخص‌های کنترل قند خون نیز گردید.

کلیدواژه‌ها

عنوان مقاله [English]

Effect of Nutrition Education on Nutritional Behaviors and Glycemic Control Indices Based on BASNEF Model among Elderly with Type 2 Diabetes

نویسندگان [English]

  • Arash Najimi 1
  • Gholamreza Sharifirad 2
  • Akbar Hasanzadeh 3
  • Leila Azadbakht 4
1 Department of Health Promotion and Health Education, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Professor, Department of Health Promotion and Health Education, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Lecturer, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: The purpose of the present study was to determine the effectiveness of nutrition education program based on the BASNEF (Belief, Attitude, Subjective Norm and Enabling Factors) model among elderly subjects above 60 years old with type 2 diabetes.Methods: In this study, 100 diabetic elderly (≥ 60 years) patients were divided into intervention and control groups randomly. Data of control and intervention groups was collected in two stages, before intervention and 12 weeks after intervention. Intervention of nutritional education was performed based on baseline assessment and BASNEF model. Finally, data were analyzed by using χ2, Student’s t and paired t-test.Findings: Our findings indicated that mean scores of knowledge and BASNEF model variables were significantly increased in the intervention group compared to the controls after intervention (P < 0.001). Also, behavioral nutrition improved significantly. The number of serving’s intake, regarding the fruit and vegetable, has been increased significantly in the intervention group (P < 0.001). HbA1c and fasting blood sugar (FBS) levels decreased significantly in the intervention group (-0.36% and 19.5 mg/dl, respectively).  Conclusion: BASNEF–based nutrition education intervention led to improve nutritional behaviors in addition to improve knowledge and attitude of diabetic elderly and it led to improve indices of glucose control during 3-month intervention. 

کلیدواژه‌ها [English]

  • Nutrition education
  • BASNEF model
  • Metabolic indexes
  • Elderly
  • Type 2 Diabetes Mellitus

مراجع

  1. Caughey GE, Roughead EE, Vitry AI, McDermott RA, Shakib S, Gilbert AL. Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. Diabetes Res Clin Pract 2010; 87(3): 385-93.
  2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
  3. Vischer UM, Bauduceau B, Bourdel-Marchasson I, Blickle JF, Constans T, Fagot-Campagna A, et al. A call to incorporate the prevention and treatment of geriatric disorders in the management of diabetes in the elderly. Diabetes Metab 2009; 35(3): 168-77.
  4. Franco OH, Steyerberg EW, Hu FB, Mackenbach J, Nusselder W. Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease. Arch Intern Med 2007; 167(11): 1145-51.
  5. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003; 290(14): 1884-90.
  6. Lustman PJ, Gavard JA. Psychosocial aspects of diabetes in adult populations. In: Aubert RE, Ballard DJ, Barrett-Connor E, Boyko EJ, Buchanon TA, Chang YF, Editors. Diabetes in America. 2nd ed. Mary Land: National Institutes of Health; 1995.
  7. Schlater A. Diabetes in the elderly: The geriatrician's perspective. Can J Diabetes 2003; 27: 172-5.
  8. Miller DK, Lui LY, Perry HM, III, Kaiser FE, Morley JE. Reported and measured physical functioning in older inner-city diabetic African Americans. J Gerontol A Biol Sci Med Sci 1999; 54(5): M230-M236.
  9. Rodriguez LM, Castellanos VM. Use of low-fat foods by people with diabetes decreases fat, saturated fat, and cholesterol intakes. J Am Diet Assoc 2000; 100(5): 531-6.
  10. Harding AH, Day NE, Khaw KT, Bingham S, Luben R, Welsh A, et al. Dietary fat and the risk of clinical type 2 diabetes: the European prospective investigation of Cancer-Norfolk study. Am J Epidemiol 2004; 159(1): 73-82.
  11. Campbell LV, Barth R, Gosper J. Unsatisfactory nutritional parameters in non-insulin-dependent diabetes mellitus. Med J Aust 1989; 151(3): 46-50.
  12. Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci 2001; 56(1): M5-13.
  13. Rizvi AA. Nutritional challenges in the elderly with diabetes. Int J Diabetes Mellit 2009; 1(1): 26-31.
  14. Sahyoun NR, Pratt CA, Anderson A. Evaluation of nutrition education interventions for older adults: a proposed framework. J Am Diet Assoc 2004; 104(1): 58-69.
  15. Salehi M, Kimiagar SM, Shahbazi M, Mehrabi Y, Kolahi AA. Assessing the impact of nutrition education on growth indices of Iranian nomadic children: an application of a modified beliefs, attitudes, subjective-norms and enabling-factors model. Br J Nutr 2004; 91(5): 779-87.
  16. Glanz K, Rimer B, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. San Francisco: Jossey-Bass; 2008.
  17. Tankova T, Dakovska G, Koev D. Education of diabetic patients--a one year experience. Patient Educ Couns 2001; 43(2): 139-45.
  18. Rezaei N, Tahbaz F, Kimiagar M, Alavi Majd H. The effect of nutrition education on knowledge, attitude and practice of type 1 diabetic patients from Aligoodarz. J Shahrekord Univ Med Sci 2006; 8(2): 52-9.
  19. Hazavehei SMM, Sharifirad GhR, Kargar M. The Comparison of Educational Intervention Effect Using BASNEF and Classic Models on Improving Assertion Skill Level. J Res Health Sci 2008. 8(1): 1-11.
  20. Baghyani-Moghadam MH, Shafiei F, Haydarneia AR, Afkhami M. Efficacy of BASNEF Model in Controlling of Diabetic Patients in the City of Yazd, Iran. Indian J Community Med 2005; 30(4): 10-2.
  21. Mohamaei F, Nouri N, Noohi F, Maleki M. Application of BASNEF health belief model in prevention the occurrence of risk factor contributing to myocardial in patients with coronary artery disease. Iranian heart journal 2004; 5(1-2): 32-29.
  22. Sharifirad G, Entezari MH, Kamran A, Azadbakht L. The effectiveness of nutritional education on the knowledge of diabetic patients using the health belief model. J Res Med Sci 2009; 14(1): 1-6.
  23. Taylor-Davis S, Smiciklas-Wright H, Warland R, Achterberg C, Jensen GL, Sayer A, et al. Responses of older adults to theory-based nutrition newsletters. J Am Diet Assoc 2000; 100: 656-64.
  24. Shabbidar S, Fathi B. Effect of nutrition education on knowledge, attitude, and practice of type 2 diabetic patients. J Birjand Univ Med Sci 2007; 14(1): 31-7.
  25. Rakhshanderou S, Gaffari M, Heydarnia A, Rajab A. Effectiveness of educational interventions on metabolic control in diabetic patients referred to the Diabetes Center of Iran. Iranian J Diabetes Lipid 2010; 9(Special Issue): 57-64.
  26. Hazavehei MM, Khani Jyhouni A, Hasanzade A, Rashidi M. The effect of educational program based on BASNEF model on diabetic (Type II) eyes care in Kazemi's clinic, (Shiraz). Iranian J Endocrinology Metab. Iranian J Endocrinology Metab 2008; 10(2): 145-54.
  27. Perez-Escamilla R, Hromi-Fiedler A, Vega-Lopez S, Bermudez-Millan A, Segura-Perez S. Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review. J Nutr Educ Behav 2008; 40(4): 208-25.
  28. Klomegah RY. The influence of social support on the dietary regimen of people with diabetes. Sociation Today 2006; 4(2): 104-8.
  29. Wilson W, Pratt C. The impact of diabetes education and peer support upon weight and glycemic control of elderly persons with noninsulin dependent diabetes mellitus (NIDDM). Am J Public Health 1987; 77(5): 634-5.
  30. Ciechanowski P, Russo J, Katon W, Von KM, Ludman E, Lin E, et al. Influence of patient attachment style on self-care and outcomes in diabetes. Psychosom Med 2004; 66(5): 720-8.
  31. Weickert MO, Mohlig M, Schofl C, Arafat AM, Otto B, Viehoff H, et al. Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care 2006; 29(4): 775-80.
  32. Qi L, van Dam RM, Liu S, Franz M, Mantzoros C, Hu FB. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care 2006; 29(2):
  33. -11.
  34. American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002; 25(1): 202-12.
  35. Pimentel GD, Arimura ST, de Moura BM, Silva ME, de Sousa MV. Short-term nutritional counseling reduces body mass index, waist circumference, triceps skinfold and triglycerides in women with metabolic syndrome. Diabetol Metab Syndr 2010; 2: 13.
  36. Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension 2008; 51(4): 1073-9.
  37. Pimentel GD, Portero-McLellan KC, Oliveira EP, Spada AP, Oshiiwa M, Zemdegs JC, et al. Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Nutr Res 2010; 30(3): 186-90.
  38. .Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health--a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Am J Clin Nutr 2008; 87(1): 258S-68S.
  39. Azadbakht L, Surkan PJ, Esmaillzadeh A, Willett WC. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr 2011; 141(6): 1083-8.
  40. Azadbakht L, Fard NR, Karimi M, Baghaei MH, Surkan PJ, Rahimi M, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial. Diabetes Care 2011; 34(1): 55-7
  41. Miller CK, Edwards L, Kissling G, Sanville L. Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus. J Am Diet Assoc 2002; 102(8): 1069-81.
  42. Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J. Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study. Patient Educ Couns 1992; 19(1): 61-74.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 155 - شماره پیاپی 155
مهر و آبان 1390
صفحه 1389-1400

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  • تاریخ دریافت: 23 اسفند 1389
  • تاریخ بازنگری:
  • تاریخ پذیرش: 17 فروردین 1401

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