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Development and pilot test of a culturally tailored menu plan for Chinese immigrants with type 2 diabetes Open Access


Other title
menu planning
type 2 diabetes
Chinese immigrants
cultural relevance
Chinese Canadians
Type of item
Degree grantor
University of Alberta
Author or creator
Deng, Feiyue
Supervisor and department
Chan, Catherine B. (Agricultural, Food and Nutritional Science)
Examining committee member and department
King-Shier, Kathryn (Nursing, University of Calgary)
Bell, Rhonda (Agricultural, Food and Nutritional Science)
Vallianatos, Helen (Anthropology)
Chan, Catherine B. (Agricultural, Food and Nutritional Science)
Yeung, Roseanne (Medicine)
Department of Agricultural, Food, and Nutritional Science
Nutrition and metabolism
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Chinese Canadians are at higher risk for developing diabetes than the general Canadian population. Although culturally tailored diabetes treatment is recommended, there is a lack of relevant dietary resources for Chinese in Canada. The objectives of this thesis were to identify components in Chinese immigrants’ diet that need improvement and the barriers to dietary adherence, to develop a culturally tailored menu plan based on the 4-A Framework, and to pilot test the feasibility and efficacy of the menu plan. The first phase, i.e., the dietary needs assessment study, was conducted among 14 Chinese immigrants with type 2 diabetes (T2D) living in Edmonton using a convergent mixed methods design. Three-day food record was used to assess diet quality and questionnaires were used to collect other diet- and diabetes-related information. One-on-one semi-structured interviews were conducted to assess the barriers to dietary adherence. The second phase, i.e., menu plan development, followed the 4-A Framework to ensure that foods in the nutrition program were Adequate, Accessible, Available, and Acceptable. Findings from the needs assessment and current nutritional guidelines were taken into account when developing the menu plan. Some participants from the needs assessment study were invited to review the menu plan outline and their feedback was used to modify the menu plan. The third phase, i.e., pilot test of the menu plan, was conducted among 17 Chinese immigrants living in Edmonton using an intervention mixed methods design. The intervention lasted for 12 weeks. Weekly nutritional counselling was provided to participants during the first 4 weeks, and participants were contacted monthly in the last 8 weeks. Diet quality, biological outcomes and diabetes knowledge were assessed pre- and post-intervention. One-on-one interviews were conducted post-intervention to learn about how the menu plan benefited participants and obstacles to adherence. Email or telephone follow-ups were conducted 2 months after study completion to obtain information regarding continued use of the menu plan and to address any further questions or suggestions. Results from the dietary needs assessment showed that the mean Healthy Eating Index (HEI) score among Chinese immigrants with T2D was 67.7±10.9. The specific dietary components that needed improvement were grains and whole grains, milk and alternatives, saturated fats and sodium. Chinese immigrants were facing personal, societal and cultural barriers to dietary adherence, including time constraints, cravings, lack of diabetes knowledge, language, lack of culturally relevant resources, lack of healthy options in restaurants, and food prices. A pilot test of the culturally tailored menu plan showed that the mean HEI increased from 72.7±8.3 to 78.0±5.4 post-intervention (p=0.010), total vegetables and fruit score increased from 7.8±2.6 to 9.1±1.6 (p=0.027), dark green and orange vegetables score increased from 3.9±1.6 to 5.0±0.1 (p=0.008), servings of milk and alternatives increased from 0.9±0.9 to 1.3±0.8 (p=0.083), servings of total grains decreased from 6.5±2.8 to 5.4±2.7 (p=0.024), food acceptability increased from 19±3 to 21±3 (p=0.039), waist circumference decreased from 90.9±8.5 to 88.8±7.6 (p=0.004), total cholesterol decreased from 216.6±51.7 mg/dl to 195.2±52.6 mg/dl (p=0.007), low-density lipoprotein cholesterol decreased from 106.9±50.8 to 88.6±54.0 (p=0.007), diabetes knowledge score increased from 4.9±1.6 to 5.8±1.2 (p=0.009). No significant changes were observed in saturated fats and sodium intake and A1C. In conclusion, a flexible, culturally tailored menu plan could be a feasible and effective tool for improving diabetes knowledge, diet quality and biological outcomes among Chinese immigrants. The research helped narrow the gap in the literature about culturally tailored dietary interventions for Chinese immigrants and provided important information about menu planning for Asian immigrants. The 4-A Framework has the potential to be generalized across cultures to guide development of culturally tailored resources for diabetes management.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Deng F, Zhang A and Chan CB. Acculturation, dietary acceptability, and diabetes management among Chinese in North America. Frontiers Endocrinology. 2013, 4:108. doi:10.3389/fendo.2013.00108

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