An Exploration into Understanding Perceptions about Food Estimation and Portion Control in Type 2 Diabetic Thai Adults: A Qualitative Study
Keywords:Portion control, Food estimation, Type 2 diabetes, Healthy food, Diabetes education, Qualitative study
Control of portion size is a crucial goal in medical nutrition therapy for people with type 2 diabetes. This study aimed to explore the understanding about food estimation and portion control in Thai adults with type 2 diabetes. Semi-structured interviews were conducted with 24 Thai adults type 2 diabetes. A deductive thematic analysis of the transcriptions of audio recording was used to create codes, an index, and themes. Four major themes were identified: (i) Misunderstandings surrounding the most appropriate diet for diabetics and sources of carbohydrate; (ii) Problems with the methods of food estimation; (iii) External factors contributing to overconsumption; (iv) Attitudes leading to malpractice. Participants misunderstood some dietary concepts, especially those surrounding carbohydrates. They perceived that rice as being a bad carbohydrate source, while fruit is a good one. Participants’ misconceptions surrounding portion controlled to inaccurate food estimation and lower varieties of food types. Diabetes educators need to clarify the concept of a healthy diet with people with type 2 diabetes as well as concepts of diabetes management and a treatment goal. The usual estimation techniques need to be adjusted to suit local Thai eating styles. The addressing of external factors affecting behavior should be of greater concern during dietary education; the factors including constraints around jobs and the social impact of family and friends.
Guariguata L, Whiting D, Hambleton I, Beagley J, Linnenkamp U, Shaw J. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabet Res Clin Pract. 2014;103(2):137-49.
Chan JC, Cho NH, Tajima N, Shaw J. Diabetes in the western pacific region—past, present and future. Diabet Res Clin Pract. 2014;103(2):244-55.
Deerochanawong C, Ferrario A. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes. Global Health. 2013;9(1):11.
Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. American Association of Clinical Endocrinologists and American College of Endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocr Pract. 2015;21(Suppl 1):1-87.
American Diabetes Association. Standards of medical care in diabetes—2017: summary of revisions. Diabetes Care. 2017;40(Suppl 1):S4-5.
Libotte E, Siegrist M, Bucher T. The influence of plate size on meal composition. Literature review and experiment. Appetite. 2014;82:91-6.
Vijan S, Stuart N, Fitzgerald J, Ronis D, Hayward R, Slater S, et al. Barriers to following dietary recommendations in Type 2 diabetes. Diabet Med. 2005;22(1):32-8.
Lakshmi R, Ganesan P, Mohan Anjana R, Balasubramanyam M, Mohan V. Exploring illness beliefs about diabetes among individuals with type 2 diabetes: An Indian perspective. Int J Pharm Healthc Mark. 2014;8(4):392-413.
Boonsatean W, Carlsson A, Östman M, Rosner ID. Living with diabetes: experiences of inner and outer sources of beliefs in women with low socioeconomic status. Glob J Health Sci. 2016;8(8):200.
Sowattanangoon N, Kochabhakdi N, Petrie KJ. Buddhist values are associated with better diabetes control in Thai patients. Int J Psychiatry Med. 2008;38(4):481-91.
Naemiratch B, Manderson L. Control and adherence: living with diabetes in Bangkok, Thailand. Soc Sci Med. 2006;63(5):1147-57.
Sowattanangoon N, Kotchabhakdi N, Petrie KJ. The influence of Thai culture on diabetes perceptions and management. Diabetes Res Clin Pract. 2009;84(3):245-51.
Wongwiwatthananukit S, Krittiyanunt S, Wannapinyo A. Development and validation of an instrument to assess the general knowledge of patients with diabetes. Thai J Pharm Sci. 2004;28:17-29.
Diabetes Association of Thailand. Clinical Practice Guideline for Diabetes 2014. Bangkok: Aroonkarnpim; 2014.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117.
Swallow V, Newton J, Van Lottum C. How to manage and display qualitative data using ‘Framework’and Microsoft® Excel. J Clin Nurs. 2003;12(4):610-2.
Sunanta S, editor. The globalization of Thai cuisine. Canadian Council for Southeast Asian Studies Conference; 2005 Oct 14-16; York University, Toronto. n.p.: 2005.
Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1-13.
Ford ES, Dietz WH. Trends in energy intake among adults in the United States: findings from NHANES. Am J Clin Nutr. 2013;97(4):848-53.
Brazeau A, Mircescu H, Desjardins K, Leroux C, Strychar I, Ekoé J, et al. Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes. Diabet Res Clin Pract. 2013;99(1):19-23.
Irvine AA, Cox D, Gonder-Frederick L. Fear of hypoglycemia: relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus. Health Psychol. 1992;11(2):135.
Tungsanga K, Ratanakul C, Pooltavee W, Mahatanan N, Ayuthaya AIN, Rodpai S. Experience with prevention programs in Thailand. Kidney Int. 2005;67:S68-9.
Gibson AA, Hsu MS, Rangan AM, Seimon RV, Lee CM, Das A, et al. Accuracy of hands v. household measures as portion size estimation aids. J Nutr Sci. 2016;5:e29.
Jonnalagadda S, Mitchell D, Smiciklas-Wright H, Kris-Etherton P, Karmally W, VanHeel N. Portion Size Estimation. J Am Diet Assoc. 1995;95(9):A21.
Meade LT, Rushton WE. Accuracy of Carbohydrate Counting in Adults. Clin Diabet. 2016;34(3):142-7.
Gerich JE, Odawara M, Terauchi Y. The rationale for paired pre-and postprandial self-monitoring of blood glucose: the role of glycemic variability in micro-and macrovascular risk. Curr Med Res Opin. 2007;23(8):1791-8.
Muchmore D, Springer J, Miller M. Self-monitoring of blood glucose in overweight type 2 diabetic patients. Acta Diabetol. 1994;31(4):215-9.
Goh SGK, Rusli BN, Khalid BAK. Evolution of diabetes management in the 21st century: the contribution of quality of life measurement in Asians. Asia Pac J Clin Nutr. 2015;24(2):190-8.
Rolls B. What is the role of portion control in weight management? Int J Obes. 2014; 38:S1-S8.
Courtenay M, Stenner K, Carey N. The views of patients with diabetes about nurse prescribing. Diabet Med. 2010;27(9):1049-54.
Bureau of Policy and Strategy, Ministry of Public Health. Public Health Statistics A.D.2016. Nonthaburi: Ministry of Public Health; 2017.
How to Cite
Upon acceptance of an article, copyright is belonging to the Nutrition Association of Thailand.