Meeting the nutrition education needs of people with diabetes in primary care: GRiP

Dietary modification is an effective treatment for Type 2 Diabetes and receiving high quality individualised dietary advice and self management education makes dietary change more likely. However opportunities for nutrition education are being underutilised. This GRIP project leads on from a Masters study ‘Exploring the provision of diabetes nutrition education by practice nurses.’

 Aim: To improve access to high quality, timely nutrition education for people with Type 2 Diabetes in Sheffield by engaging and supporting people with diabetes to identify the most appropriate source of nutrition education.

 The GRIP project will use the Theoretical Domains Framework (TDF) implementation approach, based on the COM-B model of behaviour change. (Cane et al 2012) It is recognised that just like people with diabetes, health professionals also find it difficult to change behaviour and often evidence based guidelines are not implemented (Michie et al 2005). The TDF has been used successfully in a number of knowledge mobilisation projects led by The Improvement Academy (Taylor et al 2013).


Co-production sessions with service users and stakeholders will consider what sorts of things 

get in the way of a person with diabetes accessing nutrition education and the feasibility of implementing a nutrition education decision tool during primary care appointments, to improve this access. An intervention addressing the issues that arise will be developed and piloted within several GP practices in the city.

Map of Theoretical Domains Framework (TDF) to Sources of Behavior on COM-B System.  (image from Alexander, Karyn E, Bianca Brijnath, and Danielle Mazza. 2014. “Barriers and Enablers to Delivery of the Healthy Kids Check: An Analysis Informed by the Theoretical Domains Framework and COM-B Model.” JOUR. Implementation Science 9 (1): 60. doi:10.1186/1748-5908-9-60.)


Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. 2012;1–17.

Michie, S, Johnston, M, Abraham C et al.(2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Heal Care. 2005;14(1):26–33.

Taylor N, Lawton R, Slater B et al (2013) The demonstration of a theory-based approach to the design of localized patient safety interventions. Implementation science, 8(1), p123.

Project Lead: Carla Gianfrancesco, Specialist Diabetes Dietitian, Sheffield Diabetes and Endocrine Centre, Sheffield Teaching Hospitals. Tel: 0114 2714445 (work)    Email: