A Model Exploring The Relationship Between Nutrition Knowledge, Behavior, Diabetes Self-Management And Outcomes From The Dining With Diabetes Program

To examine the relationship between changes in participant's knowledge, beliefs, dietary behavior, diabetes selfmanagement and program outcomes in West Virginia Dinning with Diabetes (DWD) program. We used a longitudinal pre-test and post-test study design and data from 2745 individuals with diabetes who participated from 2007 to 2012. The DWD was offered in community-based settings across the state as an educational program (five classes over a 3-month period). Associations between changes in the variables were examined by structural equation modeling using a path model in which changes in nutritional knowledge, beliefs and depression predicted changes in dietary behaviors and diabetes self-management which subsequently predicted program outcomes (e.g., follow-up with healthcare providers for diabetes care and education). Standardized regression weights are presented. Participant's mean age and duration of diabetes was 63 +/- 11.5 and 7.2 +/- 8.0 years, respectively. The majority were females, Whites and with less than high school education. Improvements in nutrition knowledge and belief predicted improvements in dietary behavior ( beta = 0.60, p <.001 and beta = 0.11, p <.001, respectively) and diabetes self-management ( beta = 0.61, p <.001 and beta = 0.10, p <.001, respectively) which in turn predicted improvements in program outcome ( beta = 0.41, p <.001). Diabetes self-management mediated the relationship between knowledge, dietary behavior and program outcomes. The indexes of fit for the tested model indicated a good fit [TLI =0.99, CFI = 0.95, and Root Mean Square Error of Approximation (RMSEA) =0.05]. Results indicate DWD group sessions can be effective in supporting individuals with diabetes to change knowledge, dietary behaviors, adherence to self-management and follow-up provider visits for diabetes care.