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      Preliminary Efficacy of Group Medical Nutrition Therapy and Motivational Interviewing among Obese African American Women with Type 2 Diabetes: A Pilot Study

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          Abstract

          Objective. To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). Research Design & Method. African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. Results. Participants ( n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c ( P = 0.03) and a near significant ( P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. Conclusion. The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.

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          Most cited references26

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          Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.

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            Limitations of the randomized controlled trial in evaluating population-based health interventions.

            Population- and systems-based interventions need evaluation, but the randomized controlled trial (RCT) research design has significant limitations when applied to their complexity. After some years of being largely dismissed in the ranking of evidence in medicine, alternatives to the RCT have been debated recently in public health and related population and social service fields to identify the trade-offs in their use when randomization is impractical or unethical. This review summarizes recent debates and considers the pragmatic and economic issues associated with evaluating whole-population interventions while maintaining scientific validity and credibility.
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              The multiple baseline design for evaluating population-based research.

              There is a need for pragmatic and rigorous research designs to evaluate the effectiveness of population-based health interventions. The randomized controlled trial (RCT) has limitations in its practicality, ethical appropriateness, and cost when evaluating population-based interventions. Like RCTs, the multiple baseline design can demonstrate that a change in behavior has occurred, the change is a result of the intervention, and the change is significant. Especially important practical advantages over the RCT are that this design requires fewer population groups and communities may act as their own controls. Advantages and methodologic limitations of the multiple baseline design are discussed, and where feasible, strategies to minimize the impact of its limitations are suggested. Recommendations for future research are included.
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                Author and article information

                Journal
                J Obes
                J Obes
                JOBE
                Journal of Obesity
                Hindawi Publishing Corporation
                2090-0708
                2090-0716
                2014
                28 August 2014
                : 2014
                : 345941
                Affiliations
                1Department of Surgery, Meharry Medical College, 1005 Dr. D. B. Todd, Nashville, TN 37208, USA
                2Department of Family and Consumer Sciences, College of Agriculture, Human and Natural Sciences, Tennessee State University, 224 Humphries Hall, 3500 John A. Merritt Boulevard, Nashville, TN 37209, USA
                3Department of Biostatistics, Vanderbilt University Medical Center, S-2323 Medical Center North, Nashville, TN 37232-2158, USA
                4National Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206, USA
                Author notes
                *Stephania T. Miller: smiller@ 123456mmc.edu

                Academic Editor: Bernhard H. Breier

                Author information
                http://orcid.org/0000-0003-4548-3010
                Article
                10.1155/2014/345941
                4163289
                25243082
                35b43380-3a91-499a-a171-3aeff1822fd8
                Copyright © 2014 Stephania T. Miller et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 May 2014
                : 22 July 2014
                : 31 July 2014
                Categories
                Research Article

                Nutrition & Dietetics
                Nutrition & Dietetics

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