Author ORCID Identifier
Date Available
4-30-2025
Year of Publication
2025
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
College
Nursing
Department/School/Program
Nursing
Faculty
Dr. Elizabeth Tovar
Committee Member
Dr. Brittany Roher
Faculty
Dr. Julianne Ewen
Abstract
Background: Only half of individuals with type 2 diabetes mellitus (T2DM) have a hemoglobin A1C (HbA1c) of less than 7%, indicating poor glycemic control and contributing to a global diabetes epidemic. Diabetes is considered a diet-sensitive disease and an individual’s diabetes-related nutrition knowledge is one of the most challenging aspects of the treatment plan. Empirical evidence supports that a combination of dietary and physical activity interventions is more effective than nutrition education alone. Performing a dietary evaluation is fundamental to establishing nutrition goals. The use of the Starting the Conversation (STC) tool, which assesses an individual’s dietary practices, and Physical Activity Vital Sign (PAVS) tool, which assesses an individual’s level and amount of physical activity, have shown to improve A1c and other outcomes for patients with T2DM.
Purpose: The purpose of this project was to implement and evaluate the use of the STC and PAVS screening tools for adults with T2DM in a primary care setting.
Methods: A quasi-experimental design, guided by The Iowa Model of Evidence-Based Practice to Promote Quality Care, was used. The project took place at a primary care clinic serving a low-income, underserved population in central Kentucky. Current screening practices for nutrition and exercise in individuals with T2DM were evaluated. Six clinic providers were educated on the screening tools, which were implemented over 11 business days. Demographic data, screening documentation rates, and specific patient quality metrics were measured through retrospective chart audits, while provider and patient satisfaction was evaluated through surveys.
Results: The sample size for this project included 4 providers, and 45 patients. A total of 18 completed patient packets were received, indicating a 40% patient participation rate. All the providers reported screening for nutrition and exercise in their patients with T2DM pre-intervention, and none had used the STC nor PAVS screening tools before (100%). Of the 45 notes authored during the intervention period, 66.7% (30) were authored by the medical student/resident/fellow the MD was precepting, 22.2% (10) were authored by the APRNs, and 11.1% (5) were authored by the MDs. Of the two providers (APRNs) that documented nutrition and exercise screening with the STC and PAVS tools, respectively, 0% documented in the pre-intervention, 9% documented in the inter-intervention, and 7% documented in the post-intervention (p = 0.12). All the providers agreed that the STC and PAVS screening tools helped them identify patients with T2DM who need nutrition and physical activity counseling, respectively (100%). However, 66.7% reported barriers with using and reviewing both screening tools. Most patients agreed that the STC and PAVS tools helped with diet and exercise recall (65% and 76%, respectively), and nearly two-thirds were made aware of their diet and physical activity habits through the tools. However, 41.1% did not want to discuss their diet, and 58.8% were indifferent about discussing their physical activity habits with their provider. There were no statistically significant changes in weight, or BMI, HbA1c, and glucose levels among patients (p = 0.5; p = 0.3; p = 0.42; p = 0.75).
Conclusion: In this study, implementation of the STC and PAVS screening tools for adults with T2DM in a primary care setting did not result in a statistically significant increase in the use of these tools by clinic providers nor improved glycemic control, weight, and BMI in eligible patients. However, there were clinically significant findings including increased provider documentation rates of the STC and PAVS screening tools from the pre-intervention to inter-intervention, and a subjective increase in awareness of the patients’ diet and exercise with using the STC and PAVS screening tools, respectively. Further study is warranted but the findings from this study are consistent with previous studies and support the recommendations for implementation of the STC and PAVS screening tools in this clinical setting. To improve patient outcomes, it is imperative to identify interventions that facilitate patient care and have the greatest impact on glycemic control in adults with T2DM.
Recommended Citation
Dalton, Ashley O., "Implementation and Evaluation of Diet and Physical Activity Screening Tools for Adults with Type 2 Diabetes Mellitus in Primary Care" (2025). DNP Projects. 494.
https://uknowledge.uky.edu/dnp_etds/494
