2.2.3. Adherence (Primary)
Participant adherence to the nutrition program was evaluated using participant self-rated adherence (0 = Not at all, 5 = Half of the time, and 10 = All the time, very consistent) and ketone urinalysis test strips measuring acetoacetic acid. Self-rated adherence was collected at each of the weekly online surveys and at the 3-month follow-up assessment. To evaluate self-rated adherence during the program, weekly scores were summed for analyses, with higher scores corresponding with higher adherence to MKN. Urine ketones were measured at each in-person assessment and daily at-home during the 6-week intervention. Participants were instructed on appropriate storage and use of the ketone urine test strips and provided with tracking sheets to enter their daily values. Participants were instructed to measure ketones in the morning prior to eating or drinking each day.