Factors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town

摘要

Objective: The purpose of this study was to explore the experiences of patients with type 2 diabetes mellitus attending the Groote Schuur Hospital Diabetes Clinic in relation to contextual factors that promote or impede adherence to nutrition care guidelines.Subjects and setting: Eight diabetic patients (four males and four females) attending the Groote Schuur Hospital Diabetes Clinic who were between 40–70 years old.Outcome measures: Qualitative analysis of factors influencing adherence to dietary guidelines.Method: An explorative study, using a qualitative approach with eight semi-structured interviews, was used. Patients were interviewed at the diabetes outpatient clinic in Cape Town. Semi-structured interviews were recorded and transcribed, and thereafter analysed using ATLAS/ti?.Results: Various themes as to what influences adherence to dietary guidelines emerged. An ecological analysis is offered to understand the different levels of influence on participants' dietary behaviour. The main identified factors at individual level were motivation, individual knowledge, perceptions of moderation, self- responsibility, taste concept or cravings, and temptations. At small group (family and friends) level, family relations with the patients were identified as the main support system used to manage the diabetes. At the organisational or health systems level, long waiting times and the theme of seeing different doctors emerged as problematic factors, but overall, patients were satisfied with the clinic service. At community and policy level, culture and the cost of food were identified as key influential factors with regard to adherence to nutrition care guidelines.Conclusion: This study shows the usefulness of adopting an ecological model in identifying factors that influenced adherence to dietary guidelines by patients with type 2 diabetes. Some factors acted as enablers and others as barriers. These had an impact on patient adherence to nutrition care guidelines. These factors should be considered by diabetes educators, including dietitians and nurses and doctors, when planning treatment modalities for patients with type 2 diabetes mellitus.