For decades, experts have been recommending that the public should consume a healthy, balanced diet. Despite these efforts, national nutrition surveys show that the majority of people do not follow these recommendations in daily life, with onset of diet-related illnesses as a consequence. One such illness that has risen to an unprecedented level worldwide is Type 2 Diabetes Mellitus (T2DM). Multiple studies show that energy restriction as well as lifestyle interventions including healthy eating and physical exercise lower the risk of the development of diabetes emphasized by treatment guidelines. However, initiating self-management remains a challenge. A possible cause is that most of the recommendations are nutrition and illness related, without an eye for the everyday life context of people with T2DM.
Consequently, integrating the recommended changes is problematic in the everyday-life setting. This PhD project departs from the complexity of everyday-life and uses the Salutogenic Model of Health to investigate how people with T2DM can be supported in practically and socially organising change towards eating in line with recommendations. This model complements biomedical models that indicate causes of breakdown (pathogenesis) with a solution-oriented focus and studies how people manage challenges in a health promoting way.
A systematic literature review is performed to investigate effective characteristics of lifestyle program for people with T2DM. In addition, a qualitative study performed to trace how people with T2DM give meaning to challenging life-events that have led to turning points for dietary choices along their life-course and the personal, social- and physical environmental resources they apply to face these challenges. These quantitative and qualitative findings were used to develop the SALUD lifestyle program that aims to enable people with T2DM to eat more healthily within the context of their daily life.
The SALUD lifestyle program is currently tested in a randomized controlled trial that compares ‘advice as usual’ with advice empowered with the study insights in the primary care setting. Findings aim to contribute to effective interventions that aim to accomplish change of the everyday dietary patterns of adults with T2DM.