Addressing Perceived Barriers to Dietary Adherence in Type 2 Diabetes Management: Development and Evaluation of a Targeted Intervention Strategy
Abstract
Objectives: This pilot study sought to assess the effectiveness of an intervention aimed at addressing perceived barriers to dietary adherence among patients with type 2 diabetes in Iraq in response to the critical issue of insufficient dietary compliance in diabetes management.
Material and Methods: A quasi-experimental pilot study design (single blinding for participants) was used, with 60 participants (30 in the intervention group and 30 in the control group) from the Sekanyan Health Centre in Kirkuk, Iraq. The control group continued to receive their usual care. The intervention group participated in an eight-week educational program focused on the perceived barriers to dietary adherence, followed by a one-month follow-up. Outcomes were assessed using the validated 15-item perceived barriers for the dietary adherence questionnaire (PBDAQ). Higher PBDAQ scores indicate fewer perceived barriers. The Statistical Package for the Social Sciences (SPSS), version 26, was used in the data analysis.
Results: The intervention group exhibited a notable decrease in perceived barriers from baseline to post-intervention (mean difference=-0.639, 95% CI: 0.427 to 0.850, p-value=0.004) and a significant enhancement in dietary adherence (mean difference=0.448, 95% CI: -0.668 to -0.227, p-value=0.006). The control group showed no significant changes.
Conclusion: This pilot study suggests that targeted interventions addressing the perceived barriers may enhance dietary adherence among Iraqi patients with type 2 diabetes. The findings support further investigation into integrating barrier assessment and culturally tailored strategies into standard diabetes care.
Keywords
Full Text:
PDFReferences
Magliano DJ, Boyko EJ. IDF Diabetes Atlas 10th edition scientific committee. IDF diabetes atlas [hompage on the Internet]. 10th edition. Brussels: International Diabetes Federation; 2021. [cited 2025 Jun 17] Available from: https://www.ncbi.nlm.nih.gov/ books/NBK581934/
Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, et al. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023;11:509-24.
Gabish AM, Mohammed WK. Effectiveness of health education program for type 2 diabetes mellitus patient’s self-efficacy toward managing feet at Endocrinology and Diabetes Center in Al-Rusafa Sector. INJNS 2018;31. doi: 10.58897/injns.v31i1.298.
Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018;361:k2234. doi: 10.1136/bmj.k2234.
Mahjabeen W, Khan DA, Mirza SA. Role of resveratrol supplementation in regulation of glucose hemostasis, inflammation and oxidative stress in patients with diabetes mellitus type 2: a randomized, placebo-controlled trial. Complement Ther Med 2022;66:102819. doi: 10.1016/j. ctim.2022.102819.
Hu Y, Liu H, Wu J, Fang G. Factors influencing self-care behaviours of patients with type 2 diabetes in China based on the health belief model: a cross-sectional study. BMJ Open 2022;12:e044369. doi: 10.1136/bmjopen-2020-044369.
Lu X, Xie Q, Pan X, Zhang R, Zhang X, Peng G, et al. Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy. STTT 2024;9:262. doi: 10.1038/s41392-024-01951-9.
Tinajero MG, Malik VS. An update on the epidemiology of type 2 diabetes: a global perspective. J Clin Endocrinol Metab 2021;50:337-55. doi: 10.1016/j.ecl.2021.05.013.
Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes: developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). Eur Heart J 2023;44:4043-140. doi: 10.1093/eurheartj/ ehad192.
Hussein AN, Hattab WA. Effectiveness of deep breathing exercises on obstructive sleep apnea among type 2 diabetic mellitus patients. INJNS 2023;36:100-9. doi: 10.58897/ qzv99c39.
Al-Salmi N, Cook P, D’souza MS. Diet adherence among adults with type 2 diabetes mellitus: a concept analysis. Oman Med J 2022;37:e361. doi: 10.5001/omj.2021.69.
Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD, Tegegn HG. Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clin Diabetes Endocrinol 2018;4:1-7. doi: 10.1186/s40842-018-0070-7.
Nouri K, Nazari M, Kaveh MH, Hosseini FS. Effectiveness of a health belief model-based educational intervention on treatment adherence among type 2 diabetic patients: Insights from a randomized controlled trial in Iran. J Educ Community Health 2024;11:98-106.
Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q 1984;11:1-47. doi: 10.1177/109019818401100101.
Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q 1988;15:175-83. doi: 10.1177/109019818801500203.
Khudair AH, Habeeb MB. Can the Health Beliefs Predicts High School Students’ Behavioral Intention to Adopt Heart-Health- Prevention Behavior?. PJM&HS 2022;16:511-. doi: 10.53350/ pjmhs221655.
Halali F, Mahdavi R, Mobasseri M, Jafarabadi MA, Avval SK. Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran. Eat Behav 2016;21:205- 10. doi: 10.1016/j.eatbeh.2016.03.001.
Cheng LI, Leung DY, Sit JW, Li XM, Wu YN, Yang MY, et al. Factors associated with diet barriers in patients with poorly controlled type 2 diabetes. Patient Prefer Adherence 2016:37- 44. doi: 10.2147/PPA.S94275.
Mostafa WA, Almukhtar MY. Quality of life of patients with type 2 diabetes mellitus in Mosul. Ann Coll Med 2012;38:20-6.
Alhariri A, Daud F, Almaiman A, Saghir S. Factors associated with adherence to diet and exercise among type 2 diabetes patients in Hodeidah city, Yemen. Life 2017;7:264-71.
Des Jarlais DC, Lyles C, Crepaz N, TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 2004;94:361-6. doi: 10.2105/AJPH.94.3.361.
Hijazi H, Al Abdi R, Abuhammad S, Bani Issa W, Al-Sharman A, Saadeh N, et al. Assessing the effectiveness of targeted educational interventions on enhancing self-efficacy and foot care practices among diabetic women in Jordan. Front Public Health 2025;12:1502781. doi: 10.3389/fpubh.2024.1502781.
Tsegaye GW, Tuji M, Fentie S. Proportion of traditional uvulectomy and associated factors among caregivers of children under five-years old visiting tibebe ghion specialized hospital, northwest ethiopia: a cross-sectional study. Health Sci Rep 2025;8:e70675. doi: 10.1002/hsr2.70675.
Asaad G, Sadegian M, Lau R, Xu Y, Soria-Contreras DC, Chan CB, et al. The reliability and validity of the perceived dietary adherence questionnaire for people with type 2 diabetes. Nutrients 2015;7:5484-96. doi: 10.3390/nu7075231.
Nuryani, Khomsan A, Dewi M, Dwiriani CM, Lukito W. Validity and reliability of the health belief model questionnaire for dietary patterns and physical activity in prediabetes. J Educ Health Promot 2025;14:65. doi: 10.4103/jehp.jehp_498_24.
Wilson D, Diji AK, Marfo R, Amoh P, Duodu PA, A kyirem S, et al. Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study. Plos One 2024;19:e0302914.
Fani N, Mohebbi B, Sadeghi R, Tol A, Shamshiri A. Assessing the effect of educational intervention on promoting nutrition adherence among patients with type 2 diabetes referee to south health center of tehran university of medical sciences: application of health belief model. Iran J Diabetes Metabolism 2018;17:13-22.
Mohammed AS, Adem F, Tadiwos Y, Woldekidan NA, Degu A. Level of adherence to the dietary recommendation and glycemic control among patients with type 2 diabetes mellitus in Eastern Ethiopia: a cross-sectional study. Diabetes Metab Syndr Obes 2020;13:2605-12.
Gonzalez JS, Schneider HE, Wexler DJ, Psaros C, Delahanty LM, Cagliero E, et al. Validity of medication adherence self-reports in adults with type 2 diabetes. Diabetes Care 2013;36:831-7.
Mirmiran P, Bahadoran Z, Gaeini Z. Common limitations and challenges of dietary clinical trials for translation into clinical practices. Int J Endocrinol Metab 2021;19:e108170. doi: 10.5812/ ijem.108170.
Abose S, Dassie GA, Megerso A, Charkos TG. Adherence to recommended diet among patients with diabetes mellitus type 2 on follow-up at Adama Hospital Medical College, Ethiopia. Front Med (Lausanne) 2024;11:1484071. doi: 10.3389/fmed.2024.1484071.
Wilson D, Diji AK, Marfo R, Amoh P, Duodu PA, Akyirem S, et al. Dietary adherence among persons with type 2 diabetes: a concurrent mixed methods study. PLoS One 2024;19:e0302914. doi: 10.1371/journal.pone.0302914.
Baral J, Karki KB, Thapa P, Timalsina A, Bhandari R, Bhandari R, et al. Adherence to dietary recommendation and its associated factors among people with type 2 diabetes: a cross-sectional study in Nepal. J Diabetes Res 2022;2022:6136059. doi: 10.1155/2022/6136059.
Ishii H, Suzuki H, Baba T, Nakamura K, Watanabe T. Seasonal variation of glycemic control in type 2 diabetic patients. Diabetes Care 2001;24:1503. doi: 10.2337/diacare.24.8.1503.
Hamalaw S, Salih AH, Weli S. Non-adherence to anti-diabetic prescriptions among type 2 diabetes mellitus patients in the Kurdistan Region of Iraq. Cureus 2024;16.e60572. doi: 10.7759/cureus.60572.
Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes 2019;12:589-99. doi: 10.2147/DMSO.S197159.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.