Dietary behavior and type 2 diabetes care

Objective: To explore risk factors modification, as well as barriers and facilitators for behavioral change in Mexican type 2 diabetics and their families. Methods: Risk assessment and impact evaluation included measurements on anthropometrics, diet, physical activity, nutrition knowledge, and HbA(1c). The intervention included discussion groups and promoted behavioral change on dietary risk, physical exercise, and basic diabetic knowledge of 48 urban diabetic patients and 38 relatives. The educational method consisted of cognitive refraining and situational problem solving during five meetings over an 8-month period. Results: Diabetics were older and less educated than their participating relatives (55.8 +/- 11 and 34.7 +/- 13.7 years old, and 4.5 +/- 3.4 and 7.8 +/- 3.7 years of schooling, respectively). Factors such as diet, degree of obesity, physical activity and HbA(1c), reflected that 92% of diabetic patients and 83% of their relatives were at high health risk. After the intervention, nutritional knowledge and diet-health awareness increased (p=.013 and .001 respectively); however, no significant health-risks reduction was observed. Discussion: Focus group analysis suggested that lack of support from family and health services, low income, neighborhood insecurity and misleading "popular knowledge" and advice are key barriers to behavioral change. Practice implications: The study supports the understanding of constrains to health promotion campaigns and better health provider-patient interactions in Mexican population. Additionally, the study contributes to the general knowledge of ethnic socio-cultural environment influences over health care issues, primarily to diet modifications. (c) 2005 Elsevier Ireland Ltd. All rights reserved.