Study Reveals Barriers to Dietary Adherence for Diabetes Patients in Accra

Led by Kasim Abdulai of the University of Cape Coast’s Translational Nutrition Research Group, the study surveyed 392 adults with type 2 diabetes at the 37 Military Hospital from May to October 2024. The participants were selected through systematic random sampling, and their nutritional knowledge was evaluated using the Diabetes Knowledge Questionnaire, which assesses essential aspects of carbohydrate management and meal timing. Dietary behavior was measured through the Summary of Diabetes Self-Care Activities scale, which assesses how frequently patients adhere to their recommended diets.

The findings revealed that although 74.4% of participants had good knowledge of diabetes nutrition, only 68.4% practiced good dietary habits, achieving the recommended diet at least four days a week. This results in a six percentage point gap between knowledge and dietary practice. Notably, of the 292 patients with good knowledge, 21.9%, or 64 patients, still exhibited poor eating habits.

To explore the reasons behind this discrepancy, the researchers utilized the Socio-Ecological Model, which categorizes barriers to health behavior into different levels. According to the study, 84.6% of participants reported a lack of availability of necessary foods in local markets. Cultural preferences also posed challenges, with 65.9% finding prescribed diets unpalatable. Financial constraints affected 60.1% of respondents, while 54.8% reported long waiting times in health facilities, and 50.5% encountered inconsistent access to dietitians.

Statistical analysis revealed that good nutritional knowledge increased the likelihood of adhering to dietary guidelines, with patients having 2.80 times greater odds of adherence compared to those without such knowledge. However, this positive effect was lessened among patients with lower household incomes, where adherence odds were significantly reduced. Additionally, the lack of family support further decreased adherence odds.

The study's statistical model underwent robustness checks and demonstrated strong discriminative capacity, capable of predicting dietary adherence effectively. This robustness reinforces the conclusion that while knowledge is crucial, it must be accompanied by practical support to translate understanding into action.

The research challenges long-standing assumptions in diabetes education, which often emphasize information as the primary motivator for change. The Accra data shows that without addressing structural and economic barriers, such as food availability and cultural preferences, knowledge alone will not suffice. The need for culturally appropriate dietary guidance that aligns with traditional Ghanaian cuisine is emphasized to enhance the effectiveness of dietary interventions.

The implications extend beyond Accra, suggesting that health systems need to focus on addressing socioeconomic barriers to dietary adherence in diabetes care. Potential solutions proposed include subsidizing diabetes-friendly foods, improving food supply chains, and ensuring better access to dietitians in outpatient settings. As type 2 diabetes rates rise across Africa, the findings highlight the necessity of integrating knowledge with the means to implement dietary changes at home.