Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Julianne Ewen

Committee Member

Dr. Angela Grubbs


Background: Adherence to diet is a challenging part of managing type 2 diabetes mellitus (T2DM). Guidelines recommend including a registered dietician and/or a diabetes educator. While this is the gold standard, there are barriers to implementation in primary care. The Starting the Conversation (STC) diet recall tool can aid primary care providers (PCPs) in providing brief nutrition counseling for patients with T2DM. Purpose: To evaluate the perceptions and practices of PCPs regarding dietary education and documentation for patients with T2DM after provider education and initiation of the STC tool. Methods: This was a quality improvement project using a quasi-experimental pretest post-test design, with a sample of three PCPs in one primary care clinic. Provider perceptions and subjective current practices were measured. Chart reviews provided patient A1C and provider utilization data. STC and smart phrase training was provided. The STC tool with printed dietary education was available for use in the clinic for four weeks. Results: 100% participated (three providers). Survey results revealed an increase in use of the STC tool, smart phrase, and perceived time available to provide counseling. Barriers identified were time, inadequate teaching materials, and inadequate reimbursement. There was a significant increase in dietary counseling documentation (pre=17.3% vs. post=35.4%, p=0.004) and smart phrase usage (pre=2.7% vs post=18.5%, p=