ArticleJournal of clinical and translational science2026
Development and qualitative formative assessment of pictorial paper-based and digital carbohydrate-counting educational resources for diabetes management.
Article in Journal of clinical and translational science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Tailored carbohydrate-counting (CC) resources are helpful for diabetes self-management from an educator and patient perspective. Because these resources are unavailable in Malawi, we developed both pictorial paper-based and mobile app CC resources and explored clinical dietitians' perceptions of these resources after using them in routine clinical practice. Methods: The initial pictorial paper-based CC resource was developed using foods informed by a previous study and input from clinical dietitians.Nutrient composition of foods was determined from the Malawi Food Composition Table and similar sources. We collaborated with clinical dietitians and app developers through a user-centered design/user experience approach, an iterative process to develop the mobile app CC. Five clinical dietitians then integrated both the pictorial paper-based and mobile app CC resources into routine clinical care for patients with diabetes, both inpatient and outpatient, for 10 working days. Subsequently, we conducted in-depth interviews to elicit their perceptions and analyzed the data using thematic analysis. Results: Pictures of portioned foods were displayed alongside standardized utensils, food names in English and Chichewa, net weight, carbohydrate content, and the number of carbohydrate counts. The mobile app featured the following tabs: patient profile, carbohydrate information, food comparison, carbohydrate count, and meal planning. Four themes emerged from the in-depth interviews: ease and feasibility of use; benefits to dietetic practice; challenges with using the pictorial paper-based and mobile app; and perceived areas requiring improvement. Conclusions: The pictorial paper-based and mobile app CC resources were deemed easy to use and feasible for routine diabetes counseling, hence useful in low-resource settings.
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