School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom.
PLoS One. 2024 May 7;19(5):e0302914. doi: 10.1371/journal.pone.0302914. eCollection 2024.
Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D.
A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence.
Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment).
The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.
2 型糖尿病（T2D）患者饮食建议的依从性差可能导致长期并发症，同时导致医疗保健成本和死亡率的增加。本研究旨在确定与饮食依从性相关的因素，并探讨 T2D 患者饮食依从性的障碍和促进因素。
在加纳阿散蒂地区的两家医院进行了一项同时进行的混合方法研究。对 142 名 T2D 患者进行了连续抽样调查。使用感知饮食依从性问卷（PDAQ）和经过改编的一般营养知识问卷（GNKQ-R）分别评估饮食依从性和糖尿病相关营养知识（DRNK）。选择 14 名参与者进行访谈，以探讨影响饮食依从性的因素。使用 NVivo 版本 20 软件分析定性数据，并以主题的形式呈现。此外，使用 IBM SPSS 版本 29.0 进行二元逻辑回归，以确定与饮食依从性相关的因素。
本研究中近 51%（50.7%）的参与者饮食依从性良好。在多变量逻辑回归中，发现 DRNK 得分增加（AOR=1.099，95%CI：1.001-1.206，p=0.041）和居住在城市地区（AOR=3.041，95%CI：1.007-9.179，p=0.047）与良好的饮食依从性显著相关。归纳主题分析揭示了饮食依从性的四个促进因素（获取有关饮食的信息、个人食物偏好和饮食习惯、对饮食依从性的感知益处、以及社会支持的存在）和四个障碍（无法负担推荐饮食、环境中可用食物相关的障碍、饮食建议与个人饮食习惯之间的冲突、以及与社会环境相关的障碍）。
研究结果支持需要进行干预措施，包括针对个人偏好和饮食习惯进行持续的饮食教育、扩大减贫社会干预措施以及制定政策，以改善社区中健康食品的获取。
