This is a 12 months web-based dietary intervention RCT for patients with uncontrolled T2DM with the aim to improve diabetes-related dietary KAB. We are employing existing guidelines in the development of the intervention package that will be modified to suit local context. TTM's SOC construct will be incorporated in the development of the study website, myDIDeA. We are aiming for a net improvement in the KAB score in participants of the e-intervention group, besides investigating the impact of the e-intervention on the dietary practices, physical measurements and blood biomarkers of those patients.
We hope to capture the 'teachable moment' to promote dietary behaviour change in diabetics with uncontrolled HbA1c (≥7.0%) and lower level of diabetes-specific dietary KAB (≤50% of total score). We are anticipating an increase in dietary KAB at the end of the trial, which may contribute to a better blood glucose control and ultimately prevent complication due to diabetes.
Besides offering a theory and evidence based education program, this trial will be utilising bilingual educational materials that have been modified to suit the local content. Culturally sensitive dietary intervention  and web content  leave greater impact, giving this trial an edge in helping the patients to improve their dietary KAB and achieve better glycaemic control.
This trial is capable of generating a personalised dietary intervention program for a large group of patients. At the same time, the intervention program could be accessed 24 hours using any device connected to the Internet. This will empower the patients to have total control of the intervention materials.
We will be conducting this RCT in urban hospitals, which means the respondents may be of a higher socio-economic background than average Malaysians. This may not be representative of the entire population as uptake of internet is different in the urban as compared to the rural. However, we are expecting for a better response to a web-based program in the urban area and it will be interesting to investigate responses from those with higher socio-economic status to an interactive website. This trial can be a model that is first implemented at the urban area for us to evaluate its success. If successful, it can be a precursor for policy makers to initiate more rigorous promotion of such web-based programs to other parts of the country.
Like all web-based interventions, this trial's reach also depends on the participants' responsiveness. Besides personalisation according to SOC, culture and language, the success of this intervention relies on the log-in rates and usability of myDIDeA. In order to maximise the participation of the trial patients, we will be regularly reinforcing them to log-in via e-mail and SMS.
Although qualitative assessments such as in-depth interview or focus group discussion were not part of this RCT, the outcome evaluation is supplemented by a detailed process evaluation. The process evaluation is measuring program reach, dose delivered, dose received, fidelity and implementation as well as the participants'' satisfaction with the program and acceptability. Collectively, these measures will enable us to draw conclusions about potential program enhancers and barriers if the program were to be delivered in other settings and contexts.