Barriers to Healthy Eating and Diabetes Diet Education: Divergent Perspectives of Patients and Their Providers

Abstract

Patients report that adhering to diet is the most challenging aspect of diabetes management. Provision of diet education is often delegated to health care providers, despite a lack of nutrition education and training and limited awareness of environmental and cultural challenges faced by patients. Aim. We examined perceived barriers to diet self-management among low-income minority patients with type 2 diabetes and their health care providers within a single ecosystem, to test whether providers understood patient barriers. Method. We surveyed 149 members of a safety-net clinic (99 patients, 50 providers), using barriers derived from the literature. Binomial logistic regression was applied to investigate relationships between barriers and patients’ sociodemographic variables and Pearson’s χ2 was used to compare differences in perceived barriers between patients and providers. Results. Providers expressed divergent perceptions of patients’ barriers to healthy eating, including more total barriers and little agreement with patients on their relative importance. Largest differences in providers’ perceptions of patient barriers included poor motivation, high use of fast food, inadequate family support, and lack of cooking skills—all suggesting patient inadequacy. In contrast, patients showed evidence of high motivation—in rate of blood glucose measurement and desire for diet education. Patients identified primary care providers as a main source of nutrition education, yet providers indicated lack of time for diet discussion and preferred other staff do the teaching. Conclusion. The findings from this study strongly suggest that health systems need to consider patient, provider, and system barriers when implementing nutrition education and management programs.

Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices

“…For example, the participants facilitated social support by encouraging family participation. Like this study, others have reported both supportive and discouraging effects of family involvement in diabetes management in Africa, and other parts of the world ( Abdulrehman et al, 2019 ; Bross et al, 2022 ; Chepulis et al, 2021 ; Mogre et al, 2019 ; Othman et al, 2022 ; Suglo, & Evans, 2020 ; Werfalli et al, 2020 ), necessitating the need for not only involving families in patient education but also educating them on how to prevent diabetes for themselves, as well as how to support a family member living with diabetes ( Thirsk & Schick-Makaroff, 2021 ).…”

A Systematic Review of Interventions That Address Food Insecurity for Persons With Prediabetes or Diabetes Using the RE-AIM Framework

“…Research supports that individuals with diabetes who are motivated to eat healthily may consume unhealthy foods because they are unable to afford healthy alternatives. 50 Providing relevant DSMES to address challenges to self-management when resources are limited is critical to future Food Is Medicine interventions.…”

The Harry Keen Rank Nutrition Lecture 2022. Nutritional guidelines for diabetes management: Where do they come from and do they work?

“…People with diabetes report that the most challenging aspect of diabetes management is adherence to dietary advice, and lack of adherence is often judged by health professionals as inadequacy. 34 However, other barriers to translating individualised, person-centred, evidence-based guidelines exist and include the knowledge and experience of dietitians and primary care health professionals, and the environment.…”

“…It seems to be the case that the majority of dietary intervention trials show evidence of efficacy, whatever the specific intervention, and in the absence of head‐to‐head trials there is limited evidence for one particular dietary strategy. People with diabetes report that the most challenging aspect of diabetes management is adherence to dietary advice, and lack of adherence is often judged by health professionals as inadequacy 34 . However, other barriers to translating individualised, person‐centred, evidence‐based guidelines exist and include the knowledge and experience of dietitians and primary care health professionals, and the environment.…”