Determinants of dietary self-care behaviours among Taiwanese patients with type 2 diabetes

The effects of patient characteristics on reported adherence to dietary self-care behaviours in 184 Taiwanese outpatients 40 years or older with type 2 diabetes was assessed. Patient characteristics included the presence of predisposing factors affecting diabetes adherence (knowledge and attitudes about the disease, self-efficacy, and the absence of psychological problems), enabling factors (understanding of diabetes and environmental factors affecting it), and reinforcing factors (presence of medical and social support) which were evaluated using a 72 item self-administered questionnaire with 8 subscales. Adherence was assessed by patients' reports of carrying out 7 self-care behaviours (following a diabetic meal plan, following the diabetes exchange system, eating meals providing the same amount of carbohydrate every day, counting carbohydrates, reducing dietary fat, consuming high fiber foods, and keeping a daily food record). Reported adherence ranged from 17% to 74%. No single predisposing, enabling, or reinforcing factor predicted adherence to all of the dietary self-care behaviours. However, more self-efficacy, better understanding, and a better attitude toward diabetes were associated with performing five or more of the dietary self-care behaviours examined. With respect to specific self-care behaviours, women were more likely than men to count carbohydrates (OR=5.75) and reduce fat in their diets (OR=2.57). Patients who attended more nutrition education sessions were more likely to follow diabetes meal plans (OR=2.11) and the diabetes exchange system (OR=3.07). Efforts are needed to encourage providers to teach diabetes self-care behaviours to patients and to capitalize upon demographic and psychosocial characteristics that can enhance patient adherence.