Qom University of Medical Sciences Journal

Introduction
Diabetes is one of the diseases where the patient plays a major role in its treatment.  For this disease, the comprehensive support of the treatment team, family and peers in various fields such as nutrition management and physical activity, is very important. In diabetic patients, the risk factors such as reduced physical activity and overweight can be reduced by effective interventions. In this regard, the first step is to increase their knowledge of individual risk factors such as age, weight, gender, and body mass index and diet modification. A healthy nutritional pattern first emphasizes not to consume the foods containing high saturated fats and fatty acids. Then, it emphasizes to have regular physical activity which can cause the body cells to absorb glucose by increasing the body’s metabolism, thereby lowering blood glucose levels. It also can control blood cholesterol and cause weight loss. Considering the importance of a healthy lifestyle, this study aims to determine the effect of a health promotion support program on nutritional status and physical activity of patients with type 2 diabetes.
Methods:
This is a quasi-experimental study that was conducted in 2020 on patients with type 2 diabetes in two groups of intervention (n=30) and control (n=30) who were selected by a convenience sampling method from among those referred to the endocrinology clinic of Bank Melli Hospital. The health promotion program was implemented at three steps based on Orem’s self-care theory. The first step was analysis and identification, which included examining the health status of the patient and environment. The second step was the support planning which included educational, motivational, counseling, instrumental, emotional/psychological, and social support by the family, peers, and associations, and the use of social resources. The third step was the outcome evaluation.
Data collection tools were a demographic form (including age, gender, marital status, education, and occupation), the three-day food reminder form from among 6 food groups based on the standard Iranian food pyramid (“dairy products” with 9 items, “vegetables” with 15 items, “meat, eggs and legumes” with 9 items, “bread, cereals and starches” with 33 items, “fruits” with 9 items, and “miscellaneous” including oil, sugar, sweets, chocolates, snacks, syrups, and juices), and the physical activity reminder from among aerobic exercises such as walking, jumping rope (with low intensity), running, swimming, and any activity that is an exercise, not just a daily activity, performed in the past one month. To assess the test-retest reliability of the two forms, Pearson correlation coefficient of the score of two tests was obtained 0.85 for the three-day food reminder form and 0.89 for the physical activity reminder form. Their Cronbach’s alpha value (internal consistency) were obtained 0.79 and 0.85, respectively. The score of the three-day food reminder form was between 0 and 1, where the higher score indicated better nutritional status.  Since the data of the two food and physical activity reminder forms had no normal distribution, between-group comparisons were done by using Mann-Whitney U test, and Wilcoxon test was used for within-group comparisons. The significance level was set at 0.05. All tests were performed in SPSS software, version 24.
Results
Results showed that the mean score of eating “dairy products”, “vegetables”, “fruits”, “meat,eggs, and legumes”, “bread, cereals, starches” in the intervention group were significantly different after intervention, but this difference was not significant in the control group. The physical activity score in the intervention group also showed a significant difference (P<0.001), but this difference was not significant in the control group.
Discussion
The health promotion support program is effective in improving physical activity and nutritionalstatus of patients with type 2 diabetes. Therefore, it is recommended to be used as an effectivemethod to improve the lifestyle of diabetic patients
Ethical Considerations
Compliance with ethical guidelines
This article is with code Med 84322 and in the medical ethics committee of Tarbiat Modares University dated 12/5/2019 under ethics code number IR.MODARES.REC.1399.055 and by obtaining informed consent by phone and verbally) from the participants in the research due to the conditions of the Corona epidemic. Compliance with confidentiality and privacy of information and permission to withdraw freely from the study.


Funding
This article is taken from Fatemeh Zanjani's thesis of nursing education in the direction of community health at the master's level and research approved by the specialized research council of Tarbiat Modares University.
Authors contributions
Information collector: Fatemeh Zanjani; Supervision and finalization;Written by: Sima Mohammad Khan Kermanshahi; Statistical data analysis; Mohammad Gholami Fesharaki; Obtaining information from scientific sources: Hassan Ali; Hassankhani; support of sources: Hossein Ali Sokhandan and Zahra Sadat; Dibaji Forooshani.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
We would like to express our appreciation to the respected Vice President of Research of the Faculty of Medical Sciences of Tarbiat Modares University, the respected officials of Bank Melli Hospital and the type 2 diabetes patients of Bank Melli Hospital who helped us in advancing the goals of this research.