Diabetes-related nutrition knowledge and dietary adherence in patients with Type 2 diabetes mellitus: A mixed-methods exploratory study
Abstract
Aim:
Methods:
Results:
Conclusion:
Introduction
Methods
Results
Lower DRNKa (n=21) |
Higher DRNKa (n=21) |
p-valueb | |
---|---|---|---|
Age, years (±SD) | 50 (16) | 42 (12) | 0.093 |
BMI, kg/m2 (±SD) | 28.7 (7.7) | 29.2 (6.4) | 0.787 |
Gender | 0.753 | ||
Male | 12 (57%) | 13 (62%) | |
Female | 9 (43%) | 8 (38%) | |
Ethnicity | 0.607 | ||
Chinese | 6 (29%) | 9 (43%) | |
Malay | 8 (38%) | 7 33(%) | |
Indian | 7 (33%) | 5 (24%) | |
Personal monthly income | 0.003 | ||
<SGD2000 | 15 (71%) | 5 (24%) | |
SGD2000-5999 | 5 (24%) | 16 (76%) | |
⩾SGD6000 | 1 (5%) | 0 (0%) | |
Education level | 0.029 | ||
Up to secondary | 16 (76%) | 8 (38%) | |
Pre-university | 4 (19%) | 7 (33%) | |
University/postgraduate | 1 (5%) | 6 (29%) | |
Marital Status | 0.024 | ||
Single | 4 (24%) | 11 (52%) | |
Married | 17 (81%) | 10 (48%) | |
Psychosocial self-efficacy, % score (±SD) | 75 (16) | 79 (10) | 0.253 |
Years of diabetes diagnosis, years (±SD) | 10 (10) | 8 (8) | 0.624 |
Lower DRNKa (n=21) |
Higher DRNKa (n=21) |
p-valueb | |
---|---|---|---|
Total energy (kcal) | 2094 (989) | 1961 (1191) | 0.695 |
Total carbohydrate (g) | 267.5 (145.9) | 239.5 (145.7) | 0.537 |
Total sugar (g) | 81.9 (75.3) | 63.4 (41.5) | 0.333 |
Energy contribution from carbohydrate (%) | 50.3 (10.8) | 49.5 (7.8) | 0.797 |
Energy contribution from protein (%) | 18.3 (6.0) | 16.8(4.1) | 0.346 |
Energy contribution from fat (%) | 31.4 (8.5) | 32.0 (6.5) | 0.778 |
Energy contribution from saturated fat (%) | 10.6 (3.2) | 12.0 (4.0) | 0.215 |
Alternate Healthy Eating Index 2010 score | 57.2 (10.4) | 51.1 (7.6) | 0.039 |
Vegetable | 2.6 (2.3) | 2.3 (2.2) | 0.760 |
Fruit | 2.1 (2.8) | 1.4 (1.3) | 0.338 |
Wholegrains | 1.0 (1.4) | 0.3 (0.4) | 0.042 |
Sugar-sweetened beverage and fruit juice | 3.0 (4.3) | 2.2 (3.9) | 0.490 |
Nuts and legumes | 5.9 (4.6) | 5.7 (4.6) | 0.911 |
Red or processed meat | 8.3 (2.2) | 7.1 (3.9) | 0.213 |
EPA+DHA | 3.5 (3.7) | 1.3 (2.3) | 0.025 |
PUFA | 5.6 (2.9) | 4.9 (2.3) | 0.405 |
Sodium | 6.8 (4.3) | 6.2 (3.9) | 0.605 |
Alcohol | 9.8 (0.9) | 10.0 (0.0) | 0.747 |
Quote # | Main theme Sub-theme |
Participant’s quote |
---|---|---|
Barriers to dietary adherence | ||
Obesogenic environment | ||
B1 | Limited availability of healthy food choices | “I think the environment factor also plays a role. If you are in a environment whereby the food choices is very limited right, sometimes there is (laugh) so little that you can, you know, do for your diet” (#24, Chinese woman, 32 years) |
B2 | Easy access to food high in fat and sugar | “Nowadays so much fast food going on, all those eatery outside” (#09, Malay man, 70 years) |
B3 | Work environment requiring food handling | “Because of my nature of my job, I have to teach people to cook. Six days I got aunty coming in for curry every day. You can’t expect me eat any other thing of course I want to join them in the curry. So this are some of the days and these are. . .not talking about just six curry in one day. It could be braised duck, braised meat, curry rendang and thing lar” (#29, Chinese man, 58 years) |
B4 | Social media featuring unhealthy food | “Ah I feel that now the social media like Instagram especially and you know you have people who having diabetes and conditions like this, they will stumble upon Instagram that shows you know, cakes and foods, you know those food porn kind of thing, so they tend to go astray (laugh)” (#33, Malay woman, 47 years) |
Lack of personal motivation | ||
B5 | Unmotivated to change current habits | “This really a lot difficult. We already eat so many years of white rice you suddenly got [diabetes] you need to change, a lot of thing you cannot eat” (#32, Chinese woman, 33 years) |
B6 | Being in pre-contemplative stage of change | “Is when I feel that I’m not uh, I’m not, I don’t have the diabetic, I’m a normal person. So as a normal person, I don’t need to see, think so much. Everything is okay to me” (#17, Chinese woman, 58 years) |
Lack of time | ||
B7 | Busy work schedules | “It means, uh any work factors, uh any uh timeframe that maybe didn’t didn’t fit your time to eat regularly, especially the medication and the type of food that have been prescribed on you” (#14, Malay man, 56 years) |
Conflict between advice and personal values | ||
B8 | Perception of time needed to prepare healthier food vs. time willing to use to prepare healthier food | “I would think that you need to make a lot of uh, advance preparation lar, if let’s say we do what to apply what we have learnt. Uh, ya, you need to head to the supermarket et cetera in advance [to get the so call] healthy food et cetera and you bring it yourself along” (#24, Chinese woman, 32 years) |
B9 | Perception of cost of healthier food vs. willingness/ability to pay for food | “Because normally they say, ah this one is diabetic friendly, then you choose the product which is cheaper, and maybe taste nicer, but may not be diabetic friendly”(#27, Malay Man, 60 years) |
B10 | Perception of healthier food vs. personal food preferences | “But if I eat something like bread, you know, wholemeal bread. At the beginning yes, I can eat you know, but in a run ar, wah, I cannot take it already, you know. I don’t feel fulfil” (#30, Malay man 45 years) |
B11 | Perception that foods appropriate for one’s culture are unhealthy | “Because like especially uh tsk, for us Malay ar you know one, all the dishes ar all like, tsk, can be very oily this sort of things” (#30, Malay man 45 years) |
Stress from external sources | ||
B12 | Pressure from family to control condition | “Probably is uh feel very stressful, very. . . . u know, stressful and very irritated. When getting. . . angry sometime when you cannot have what do you want lar, so your family control” (#04, Indian man, 55 years) |
B13 | Stress from unsupportive friends | “Friends also important. When you go out, you see them eat you cannot eat, this is also one of the difficulty” (#32, Chinese woman, 33 years) |
B14 | Financial stress from cost of diabetes | “Outside, whenever you eat outside, the, that’s not very much like range of healthy food right. And then furthermore ju- to- just to control the diabetes, the medicine and the items for example the test strips, the glucose test strip. . . . . . is very very expensive” (#18, Malay woman, 32 years) |
Gaps in diabetes-related nutrition knowledge | ||
B15 | Lack of knowledge | “But those who have no knowledge, they don’t know you can substitute this for that, which is more healthier” (#27, Malay man, 60 years) |
B16 | Unable to retain knowledge | “And I think the main factor is for for the health authority to just keep on educating people like us who are maybe not uh savvy, incompetent or that kind of stuff” (#14, Malay man, 56 years) |
Enablers to dietary adherence | ||
Presence of social support | ||
E1 | Support from healthcare professionals | “Uh, in the hospital, the. the professional people lar are helping me lar” (#06, Indian woman, 41 years) |
E2 | Support from friends/peers | “Having friends who have uh same kind of uh, you know, uh having diabetes as you, same as you. So, you can actually help uh encourage each other, you know uhm is better than being alone, I think having someone to correlate to actually really helps me a lot on this lar” (#24, Chinese woman, 32 years) |
E3 | Support from religious movement/beliefs | “God can help” (#10, Chinese man, 80 years) |
E4 | Support from family members | “Outside my whole family very sad about my toe. And my daughter explained to me: Mum, you can’t take mum, you’ve to take care, everything must stop” (#13, Indian woman, 56 years) |
Presence of personal motivation to improve condition | ||
E5 | Individual responsibility towards managing condition | “h I think in terms of my understanding, uh, we need to really take active concern of our health. After all at the end of the day, we are the one who are facing the music, if we don’t really take good care of it lar” (#14, Malay man, 56 years) |
E6 | Recognition of importance of diet control | “To get correct food ar, in order not to increase our diabetes lar” (#04, Indian man, 55 years) |
Fear of diabetes complications | ||
E7 | Fear of suffering | “Oh, because I’ve been through with all the symptoms. My sugar is pretty high before, like this time, this time was the highest ah 29.9. need to go toilet more often., then pain in your privates, alright, then the foreskin is tighten, then you have constipation, then you have like tiredness, you get really tired” (#05, Chinese man, 43 years) |
E8 | Fear of death | “I have a friend that have already passed away because of uhm from diabetes leads to kidney and affect all the other organs, the body. So, he was quite young around my age, thirty two!” (#18, Malay woman, 32 years) |
Sufficient diabetes-related nutrition knowledge | ||
E9 | Availability of resources that can help patients improve their diabetes-related nutrition knowledge | “So I think these knowledge, information and this kind of thing will help to educate patient like me to to have a better life lar. To practice more healthy diet and so on. . . . we need to educate this every on ongoing” (#14, Malay man, 55 years) |
Discussion
Conclusion
Acknowledgments
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Informed Consent
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This article was published in Proceedings of Singapore Healthcare.
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