Factors influencing diet adherence among diabetes mellitus type 2 patients attending clinic at moi teaching and referral hospital, Kenya

Abstract

Non-communicable diseases are the leading cause of death globally and Diabetes Mellitus is the fourth contributor. In 2017 there were 458,200 cases of Diabetes Mellitus in Kenya with more than 85% being Diabetes Mellitus Type 2. Complications resulting from poor glycemic control seen in Kenyan hospitals could be attributed to poor dietary practices. Therefore, the main objective of this study was to determine factors that influence diet adherence among patients with Diabetes Mellitus Type 2 at the Cancer and Chronic disease Centre diabetic clinic Moi Teaching and Referral Hospital. The specific objectives of the study were to assess diet adherence of the Diabetes Mellitus Type 2 patients, determine the factors influencing diet adherence at individual, small group, organizational or health care system, community and policy levels and to determine the relationship between factors at individual level, small group, organizational or health system, community and policy and diet adherence using the ecological approach. A cross-sectional study design was conducted at the Cancer and Chronic Diseases Center at Moi Teaching and Referral Hospital in Eldoret, with a sample size of 241 respondents derived from the target population of 412. Data was collected using questionnaires, food frequency questionnaire and a three-day food record for assessing diet, and interviews for health workers as key informants. Descriptive statistics was used to assess diet adherence, chi-square and odds ratio used to identify factors at individual, small group, organizational or health care system, community and policy levels influencing diet adherence, relationships between diet adherence and the four levels perceived to influence diet adherence was determined using multiple linear regression. The mean level of adherence to recommended dietary guidelines for Diabetes Mellitus Type 2 patients was 48.6%. Chi-square results indicated that at individual level factors that influence diet adherence were, marital status χ² (1) =2.113, p≤.05, monthly income χ² (2) =1.461, p≤.05, duration of Diabetes Mellitus χ² (4) =3.931, p≤.05, frequency of monitoring blood sugar levels χ² (1) =4.551, p≤.05, treatment for Diabetes Mellitus χ² (2) =10.503, p≤.05 and BMI χ² (10) =18.997, p≤.05. However there was no significant association with cognitive and psychological factors at individual level perceived to influence diet adherence p˃0.05. There was also no significant association with diet adherence and factors perceived to influence adherence at small group, organizational or health care system, and community and policy levels. However multiple linear regression results indicated that 43% of variance in diet adherence can be explained by individual, small group, organizational or healthcare systems, community and policy level factors collectively, F (4,241)=2.142, p<.05. Factors at individual level had the largest standard coefficient value (β=.160, t=2.332, p=.018) indicating greatest relationship with diet adherence. Results from this study indicate that though individual factors greatly determine diet adherence, individual behaviour is influenced by factors in the environment. Therefore health professionals and policy makers should incorporate factors at small group, organizational or healthcare system, community and policy levels in improving the nutrition care process of diabetic patients.