Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting

  • Jane W Muchiri
  • Gerda J Gericke
  • Paul Rheeder
Keywords: adaptation, diabetes self-management education, type 2 diabetes, nutrition education, nutrition education programme



The purpose of this study was to adapt a diabetes nutrition education programme (NEP) developed for a primary healthcare setting for implementation in a tertiary healthcare setting. This manuscript describes the processes and considerations that were made.


Four key steps for adapting interventions identified from the literature were used. The steps included (i) assessing the needs and logic model of change, (ii) assessing the applicability of the NEP components to the new setting, (iii) making adaptations, and (iv) planning for implementation and evaluation. In the various steps, patients and health professionals were involved mainly using qualitative methods: needs assessment (n = 28 and n = 10), making adaptations (n = 10 and n = 10) respectively, and patients (n = 5) in step four.


Knowledge, self-efficacy and outcome expectations were identified as the main behaviour determinants in tertiary patients; therefore, the adapted NEP retained social cognitive theory as its foundation. The adapted NEP included new behaviour change techniques, particularly self-monitoring (behaviour and outcome) and vicarious learning using testimonials of successful management. The adapted NEP retained the original NEP components except the vegetable gardening demonstration. By incorporating monthly, instead of weekly group training sessions, a session for setting individual goals, provision of a workbook and additional relevant information, the adapted NEP catered for the tertiary patients’ needs.


The comprehensive adaptation process involved input from key stakeholders, which increases the chances of intervention effectiveness. The adapted NEP is being implemented through a randomised controlled trial and its evaluation will illuminate the impact of the changes made to the original NEP.

How to Cite
Muchiri, J. W., Gericke, G. J., & Rheeder, P. (2021). Adapting a diabetes nutrition education programme for adults with type 2 diabetes from a primary to tertiary healthcare setting. South African Journal of Clinical Nutrition, 34(1). Retrieved from
Original Research