title: Diet self-management and readiness to change in underserved adults with type 2 diabetes.
abstract: OBJECTIVE
  Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample.
  
  
  METHODS
  Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC.
  
  
  RESULTS
  Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05).
  
  
  CONCLUSIONS
  Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration.
authors.affiliation: University of Louisville, United States.
authors.forename: Holly
authors.initials: H
authors.lastname: Knight
authors.affiliation: University of Louisville, United States. Electronic address: Barbara.stetson@louisville.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stetson
authors.affiliation: University of Louisville, United States.
authors.forename: Sathya
authors.initials: S
authors.lastname: Krishnasamy
authors.affiliation: University of Louisville, United States.
authors.forename: Sri Prakash
authors.initials: SP
authors.lastname: Mokshagundam
mesh_terms: D001741:Black or African American / Q000523:psychology; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000178:diet therapy* / Q000208:ethnology / Q000523:psychology; D004032:Diet / Q000009:adverse effects; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000208:ethnology; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D012307:Risk Factors; D012648:Self Care; D012737:Sex Factors; D015144:Southeastern United States / Q000453:epidemiology; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000208:ethnology / Q000523:psychology*; D044465:White People / Q000523:psychology
keywords: Diabetes; Medically Underserved; Self-care; Self-report measures