Development and testing of a standardized training manual : diet and the nutritional management of diabetes mellitus : a comprehensive guide for health practitioners

[摘要] ENGLISH SUMMARY : Objective: To develop and test a marketable, Continuing Professional Development (CPD) accredited training manual focused on the role of medical nutrition therapy (MNT) for healthcare professionals (HCP) of the multidisciplinary Type 1 and Type 2 Diabetes Mellitus (DM) management team.Methods: The study consisted of two components: (a) development of the MNT manual and (b) testing of the MNT manual. The development of the MNT manual consisted of seven steps: (1) needs assessment and problem definition; (2) literature search; (3) draft one of the MNT manual; (4) peerreview; (5) draft two of the MNT manual; (6) evaluation by means of a survey; and (7) the final MNT manual.The testing of the MNT manual's impact on knowledge had a test-retest design which consisted of seven steps: (1) DM knowledge questionnaire development; (2) participantrecruitment; (3) questionnaire pilot; (4) initial knowledge testing; (5) self-study of MNT manual; (6) retesting of knowledge; (7) statistical analysis.Results: From the literature a total of 132 published documents were selected for inclusion in theMNT manual after grading of the information. The first draft was compiled and sent for peer review and language editing. Recommended changes were made and the seconddraft was developed and sent to 79 registered dietitians (RDs) who volunteered to complete a survey after reading the MNT manual. The survey indicated that the majoritywere satisfied with the content, which in turn led to the final MNT manual.The questionnaire was compiled using the content of the MNT manual and creating 10 questions per section of the manual. The pilot was conducted using 10% (n = 7) of the total sample. Minor changes were made. For knowledge testing, participants included RDs between the ages of 23 and 60 years, registered with the Health Professions Council of South Africa. A test-retest design wasused. Participants scored a mean of 57.5% on the initial knowledge questionnaire (KQ1), ranging between 33.6% and 79.8%. They lacked knowledge on: management ofthe hospitalised patient; diabetes and exercise; diabetes and religion; gestational diabetes; supplements commonly used by diabetics; diabetes in prisons; diabetes in children; the function, side-effects and contra-indications of metformin. The mean score on the second knowledge questionnaire (KQ2) increased to 90.5%, with the lowest score 50.4% and the highest 99.2%.There were two questions where participants scored < 50% (mean of n = 79) which related to the type of insulin regime most suitable during Ramadan and risk factors for Type 2 DM in children.Data were also analyzed according to various socio-demographic variables, but only one significant difference was found between groups.Conclusions and implications: There is adequate research available to develop a comprehensive guide for HCP on thenutritional management of DM. Such an MNT manual should be marketed for CPD purposes to encourage HCP to improve their DM management skills, as seen by the dramatic improvement in DM management knowledge of the RDs participating in this research. Future studies may include knowledge testing of other HCP, as well as testingto determine if the newly acquired information is put into practice to the benefit of DM patients.

[发布机构] Stellenbosch University