The transcultural diabetes nutrition algorithm toolkit: survey and content validation in the United States, Mexico, and Taiwan.
BACKGROUND
Evidence demonstrates that medical nutrition therapy (MNT) in prediabetes and type 2 diabetes (T2D) improves glycemic control and reduces diabetes risks and complications. Consequently, MNT is included in current clinical practice guidelines. Guideline recommendations, however, are frequently limited by their complexity, contradictions, personal and cultural rigidity, and compromised portability. The transcultural Diabetes Nutrition Algorithm (tDNA) was developed to overcome these limitations. To facilitate tDNA uptake and usage, an instructional Patient Algorithm Therapy (PATh) toolkit was created. Content validation of tDNA-PATh is needed before widespread implementation.


METHODS
Healthcare providers (n=837) in Mexico (n=261), Taiwan (n=250), and the United States (n=326) were questioned about challenges implementing MNT in clinical practice and the projected utilization and impact of tDNA-PATh. To assess the international portability and applicability of tDNA-PATh, the survey was conducted in countries with distinct ethnic and cultural attributes. Potential respondents were screened for professional and practice demographics related to diabetes. The questionnaire was administered electronically after respondents were exposed to core tDNA-PATh components.


RESULTS
Overall, 61% of respondents thought that tDNA-PATh could help overcome MNT implementation challenges, 91% indicated positive impressions, 83% believed they would adopt tDNA-PATh, and 80% thought tDNA-PATh would be fairly easy to implement.


CONCLUSIONS
tDNA-PATh appears to be an effective culturally sensitive tool to foster MNT in clinical practice. By providing simple culturally specific instructions, tDNA-PATh may help to overcome current impediments to implementing recommended lifestyle modifications. Specific guidance provided by tDNA-PATh, together with included patient education materials, may increase healthcare provider efficiency.
1 Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts.
Osama
O
Hamdy
Albert
A
Marchetti
Refaat A
RA
Hegazi
Jeffrey I
JI
Mechanick
D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000208:ethnology / Q000517:prevention & control; D003927:Diet, Diabetic; D005260:Female; D006801:Humans; D008019:Life Style / Q000208:ethnology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D044623:Nutrition Therapy; D009752:Nutritional Status; D011236:Prediabetic State / Q000097:blood / Q000178:diet therapy* / Q000208:ethnology; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires / Q000592:standards*; D013624:Taiwan / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data
D001786:Blood Glucose