A cross-sectional study of dietary non-adherence and perceived barriers of people living with type 2 diabetes mellitus in a rural community in the Ashanti region of Ghana.

Introduction: diabetes is undergoing an epidemiologic transition in sub-Saharan Africa, driven by factors such as the westernization of the African diet and changes in personal lifestyle. This transition of the African diet is seen more in urban than rural communities. Dietary counseling is subject to non-adherence because people living with type 2 diabetes mellitus (T2DM) are often counseled on diets that are usually difficult to come by in rural communities, and are unpalatable for some. This study, therefore, aimed to investigate dietary non-adherence and perceived barriers to the recommended diet among individuals living with T2DM in a rural community in Ghana. Methods: a descriptive cross-sectional survey design with a quantitative approach was used to assess the dietary adherence/non-adherence to dietary counseling of 208 T2DM participants receiving care at the new Edubiase government hospital. Dietary non-adherence was measured as an outcome variable against predictors such as socio-demographic factors, biological risk factors, duration of T2DM, presence of comorbidities (hypertension), and knowledge of T2DM. Results: females were the majority, 73.6% (n=153), and the average age was 58 (SD ±11.9). The prevalence of non-adherence was 39.42% (n=82). About 24.5% (n=51) of the participants ate fruits and vegetables 25% (n=52) every time in their main meal. A total of 43.3 % (n=90) of the participants were engaged in inappropriate dietary habits. The majority cited food unavailability 84.6% (n=176), inaccessibility 80.8% (n=164), and financial constraints 60.1% (n=125) as perceived barriers to dietary non-adherence. The majority, 65.9% (n=137) of the participants, indicated that food preferences and taste contribute to non-adherence to diabetic diets. Among participants who adhered to the recommended diet, females with tertiary education and T2DM onset of less than 5 years were associated with higher adherence (females -aOR = 7.33, 95% CI = 2.33-22.99, P = .001, aOR = 3.69, 95% CI = 1.53-8.88, P = .001). Participants who did not use complementary herbal remedies had higher odds of adhering to dietary recommendations compared to those who used herbal remedies (aOR = 6.53, 95% CI = 2.34-18.23, P = .001). Among participants who were not adhering to recommended diets were those who had poor knowledge of T2DM management and a high Waist-to-Hip Ratio (WHR) (aOR = 7.97, 95% CI = 2.61-24.31, P = .001, aOR = 0.06, 95% CI = 0.01-0.33, P = .001). Conclusion: the high rates of non-compliance with dietary recommendations underscore the need for comprehensive and targeted interventions to address the multifaceted barriers faced by persons living with T2DM in rural communities.