Facilitators and Barriers to Adherence to Nutrition Counseling Sessions Among Patients with Type 2 Diabetes at Nakuru County Referral Hospital

Abstract

Abstract Type 2 diabetes mellitus is a metabolic disorder characterized by elevated blood glucose levels caused by insulin resistance and relative insulin deficiency. Nutrition counseling is an evidence-based nutrition care process provided by a licensed healthcare provider that promotes healthy eating habits, portion control, and informed dietary choices. However, research on adherence to nutrition counseling sessions in Kenya remains limited. The study examined the Facilitators and Barriers to Adherence to Nutrition Counseling Sessions among Patients with Type 2 Diabetes at Nakuru County Referral Hospital. The study applied a mixed-methods research design, an explanatory sequential design, and involved 396 patients with type 2 diabetes and 4 healthcare providers. The study participants were selected through probability and purposive sampling. The study combined cross-sectional and phenomenological approaches. Data was collected using research-administered questionnaires, in-depth interview guides, and key informant interview guides. Quantitative data were analyzed using SPSS (Version 26). Descriptive statistics was used to summarize data. The relationship between selected variables was tested using the chi-square test, and Logistic regression was used to predict outcome variables. Qualitative data were analyzed using inductive thematic analysis and presented based on the high-ranking themes with quotes from the respondents. The study revealed that most respondents were female (62%) and in the 51-70 age bracket, potentially facing challenges in managing diabetes due to comorbidities and physical limitations. Education levels varied, with 43.5% having at least primary education and 13.5% having no formal education. Additionally, 36.1% were not currently employed. This study found that adherence to nutrition counseling sessions was low. Health status data showed that 88.1% had been diagnosed with Type 2 diabetes for over a year, and yet 45.2% had not attended nutrition counseling sessions in the past six months, and 32.7% had attended only once, indicating non-adherence. Chi-square tests revealed no significant association between adherence and socio-demographic factors (p > 0.05), while logistic regression revealed health-related factors, such as complications (p = 0.036) and regular clinic attendance (p = 0.001), as significant predictors of adherence. Barriers to adherence identified included financial constraints, comprehension issues, and logistical challenges, while enablers included positive perceptions of nutrition counselling sessions, positive reception from healthcare providers, and family support. The study recommends strategies to improve patients' access to essential diabetes management services, such as integrating nutrition counseling sessions into diabetic support groups and routine care visits to reduce costs and enhance convenience, which could improve adherence rates and patient health outcomes.