Background: American Indian and Alaska Native (AI/AN) people have high rates of diabetes and limited access to nutrition education. The "What Can I Eat?" (WCIE) diabetes nutrition education program was culturally adapted for AI/AN adults.
Objective: This analysis was designed to evaluate the reliability and validity of items developed to measure diabetes nutrition self-efficacy (i.e., confidence one can engage in specific behaviors) and diabetes nutrition behavior among participants in the WCIE program for AI/AN adults.
Design: This study was a secondary analysis of data from a randomized controlled trial designed to evaluate the WCIE program for AI/AN adults. Baseline data were used to assess the reliability and validity of the self-efficacy and behavior items, which were collected via survey. Due to COVID-19 safety protocols, the intervention was conducted via Zoom, and both survey and clinical data were collected at home by participants.
Participants/setting: The study was conducted from January to December 2021 with five AI/AN-serving health care programs in Oklahoma, Illinois, North Carolina, California, and New York. AI/AN adults with type 2 diabetes who spoke English and had Internet access were eligible. Sixty participated.
Main outcome measures: Analyses examined validity and reliability of diabetes nutrition self-efficacy and behavior items.
Statistical analysis performed: To test reliability, internal consistency and factor structures of the scales were examined. To evaluate convergent validity, Pearson correlations were computed to examine the association of the self-efficacy and behavior measures with each other and with clinical indicators (i.e., Body Mass Index, blood pressure, hemoglobin A1C).
Results: Two self-efficacy factors were identified. Each showed strong internal consistency (Cronbach alphas ≥ 0.85; McDonald omegas ≥ 0.88) and was directly associated with diabetes nutrition behavior (Ps < 0.001). The factor assessing Confidence in Using the Diabetes Plate was inversely associated with A1C (Pearson Correlation = -0.32, P = 0.0243). The behavior measure capturing Healthy Nutrition Behavior showed strong internal consistency (alpha = 0.89; omega = 0.92) and was inversely associated with A1C (Pearson Correlation = - 0.38, P = 0.0057).
Conclusions: Diabetes nutrition self-efficacy and behavior items developed for the WCIE program for AI/AN adults are valid and reliable. These items can facilitate rigorous and consistent evaluation of the AI/AN WCIE program.
Keywords: American Indians and Alaska Natives; Diabetes Self-Management Education and Support; Nutrition Education; Type 2 Diabetes Mellitus; Validation Study.
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