title: Participants' perceptions of a group based program incorporating hands-on meal preparation and pedometer-based self-monitoring in type 2 diabetes.
abstract: BACKGROUND
  Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants' perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants' perspectives.
  
  
  METHODS
  Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions.
  
  
  RESULTS
  Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes.
  
  
  CONCLUSIONS
  Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors.
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
authors.affiliation: School of Medicine, Division of Health Behavior Research, Washington University, St. Louis, Missouri, United States of America.
authors.forename: Soghra
authors.initials: S
authors.lastname: Jarvandi
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Mirella
authors.initials: M
authors.lastname: De Civita
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Pillay
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hajna
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Rejeanne
authors.initials: R
authors.lastname: Gougeon
authors.affiliation: Community Diabetes Education Program of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Abeer
authors.initials: A
authors.lastname: Bader
authors.affiliation: Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Da Costa
mesh_terms: D056044:Actigraphy / Q000295:instrumentation*; D015190:Blood Glucose Self-Monitoring; D003296:Cooking; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005190:Family; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D062407:Meals; D012944:Social Support; D011795:Surveys and Questionnaires