Understanding Dietary Adherence in Elderly Diabetes Patients

176 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1997.Patients who regularly adhere to diabetes regimens achieve better short- and long-term health. Diet is the most difficult area of behavior change, with only 65% of patients adhering to recommendations. Little is known about what influences adherence in older patients, even though they comprise the majority of those who need care. Therefore, the research objective was to understand dietary adherence in elderly diabetes patients. Two models, the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB), were chosen. Neither model had been previously studied in older diabetes patients. In a preliminary study of elderly, male diabetes patients, the TPB predicted dietary adherence. A multisite clinical study extended this work by including women and inpatients; the results suggested that HBM variables influence dietary adherence. Combined data from the two studies was analyzed to investigate the discrepancy between the results. Reliability, using Cronbach's $\alpha,$ provided an explanation. The TPB variables were in the acceptable range; however, only one of the four HBM variables fell within it. This implies that HBM variables were either not well measured or that they are not measurable. In 1994 the American Diabetes Association released new dietary recommendations that differed substantially from previous ones. A survey of dietitians (n = 102) indicated that under the new recommendations there is more flexibility in food choice for patients, and that consistency of meal schedule and using standard portion sizes were the two most important dietary behaviors. These two behaviors were studied using TPB in a community sample (n = 46). Attitude was the most powerful predictor of intention to eat on a consistent schedule, whereas an interaction between attitude and perceived behavioral control was the most powerful predictor of intention to eat standard portion sizes. Adherence for both behaviors was not predicted by TPB variables, but rather by past behavior. In conclusion, behavioral models can be useful in understanding, and possibly, improving dietary behavior in a variety of situations; and the TPB in particular shows promise in understanding dietary adherence in elderly diabetes patients.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD