THE LEVEL OF ADHERENCE TO DIABETES DIETARY REGIMEN AMONG DIABETIC PATIENTS AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH)

ABSTRACT

This study examines the level of adherence to diabetes dietary regimen among diabetic patients at the University of Nigeria Teaching Hospital (UNTH). Specific objectives include determining adherence levels, exploring socio-economic and demographic factors affecting adherence, assessing psychosocial influences, and identifying health worker support towards dietary counselling. A descriptive cross-sectional survey was conducted among diabetic patients receiving outpatient clinic care and treatment in medical wards at UNTH, Ituku Ozalla, Enugu state.

Sample size calculation was based on a diabetes prevalence rate of 3.5% in Nigeria, resulting in a sample size of 110. Data were collected using a structured questionnaire covering socio-economic, demographic, medical, and psychosocial factors. Questionnaire validity was ensured through validation by experts in Human Nutrition and Dietetics. Descriptive statistics including frequency, mean, and standard deviation were computed using SPSS. Correlation analysis was performed to determine factors influencing adherence. Adherence levels were scored on a scale of 1-8, with higher scores indicating better adherence. Significance was set at p<0.05.

The study reveals generally poor adherence rates to diabetes dietary regimen among patients at UNTH. Socio-economic status significantly influences adherence, highlighting the need for tailored interventions. Lack of patient understanding, negative perceptions of health worker attitudes, and limited nutrition education contribute to suboptimal adherence. Improved patient education, empowerment, and collaborative patient-provider relationships are crucial for enhancing adherence and health outcomes in diabetes management.

It was recommended among other recommendations to support and empower patients with diabetes to enhance self-sufficiency and self-management skills, particularly through diabetes self-management education programs. Also. organize dietary workshops, exercise programs, and self-care monitoring initiatives to improve patient knowledge and skills in managing diabetes. Engage the media in educational campaigns, counsel family members on the importance of dietary adherence and healthy lifestyles, and organize outreach programs in communities to raise awareness and promote behaviour change.

TABLE OF CONTENTS

CHAPTER 1

INTRODUCTION

1.1       Statement of the problem

1.2       Objectives of the study

1.3       Significance of the study

CHAPTER TWO

LITERATURE REVIEW

2.1       The Concept of Diabetes Mellitus

2.1.1    Classification of Diabetes Mellitus

2.2       Causes of Diabetes Mellitus

2.3       Symptoms of Diabetes Mellitus

2.4       Complications of Diabetes Mellitus

2.5       Management of Type 2 Diabetes Mellitus

2.6       Dietary Management of Diabetes Mellitus.

2.6.1    Calories

2.6.2    Carbohydrates.

2.6.3    Protein.

2.6.4    Fats.

2.6.5    Vitamins and minerals.

2.6.6    Dietary fiber.

2.7       Concept of Adherence

2.7.1    Non adherence to dietary regimen

2.7.2    Factors which predispose to Non adherence

2.7.3    Maximizing Adherence

CHAPTER 3

MATERIALS AND METHODS

3.1       Study Design

3.2       Area of Study

3.3       Population of the Study

3.4       Sampling and Sampling Technique

3.4.1    Sample Size

3.4.2    Sampling Procedure

3.5       Preliminary Activities

3.5.1    Preliminary Visit

3.5.2    Training of Research Assistant

3.5.3    Ethical Approval

3.6       Data Collection.

3.6.1    Questionnaire Administration

3.7       Anthropometric Measurement and Index

3.7.1    Weight Measurement

3.7.2    Height Measurement

3.73     Body mass index (BMI).

3.8       Statistical Analysis

CHAPTER 4

RESULT AND DISCUSSION

4.1       Socio-Economic Characteristics of Respondents

4.2       Anthropometric Indices of Respondents.

 4.2.1   Recommended Dietary Regimen for Diabetes, Using Locally Available Foods

4.2.2    Level of Adherence to Diabetes Dietary Regimen among Underweight-Diabetic

Patients

4.2.2b summary of level adherence to dietary regimen among underweight-diabetes

4.2.3    Level of Adherence to Diabetes Dietary Regimen among Normal Weight-Diabetic

Patients

4.2.3b Summary of level adherence to diabetes dietary regimen among Normal weight-

diabetics

4.2.4    Level of Adherence to Diabetes Dietary Regimen among Overweight-Diabetic

Patients

4.2.4b Summary of level of adherence to dietary regimen among overweight-diabetics

4.2.5    Level of Adherence to Diabetes Dietary Regimen among Obese-Diabetic Patients

4.2.5b Summary of level of adherence to dietary regimen among obese-diabetic

4.2.6    Total Level Adherences to Diabetes Dietary Regimen among Respondents.

4.3       Relationship between Socio-Economic and Demographic Factors with Adherence and Non Adherence of Respondents

4.4       Influences of Psychosocial Factors towards Adherence and Non Adherence among Respondents

4.5       Health Workers Support towards Adherence and Non Adherence

CHAPTER 5

CONCLUSION AND RECOMMENDATION.

5.1       Conclusion

5.2       Recommendations

LIST OF TABLE

Table 4.1         Socio Economic Characteristics of Respondents

Table 4.2         Anthropometric indices of Respondents

Table 4.2.1      Recommended Dietary Regimen for Diabetes, Using Locally Available Foods

Table 4.2.2           Level of Adherence to Diabetes Dietary Regimen among Underweight Diabetic Patients

Table 4.2.2b    Summary of level adherence to dietary regimen among underweight-

diabetes

Table 4.2.3      Level of Adherence to Diabetes Dietary Regimen among Normal Weight-

Diabetic Patients

Table 4.2.3b    Summary of level adherence to diabetes dietary regimen among Normal

weight-diabetics

Table 4.2.4      Level of Adherence to Diabetes Dietary Regimen among Overweight-

Diabetic Patients

Table 4.2.4b    Summary of level of adherence to dietary regimen among overweight-

diabetics

Table 4.2.5      Level of Adherence to Diabetes Dietary Regimen among Obese-Diabetic

Patients

Table 4.2.5b    Summary of level of adherence to dietary regimen among obese-diabetic

Table 4.2.6      Total Level of adherence among respondents

Table 4.3         Relationship between socio-economic and demographic factors with

adherence and non adherence of respondents

Table 4.4         Influence of psychosocial factors towards adherence and non adherence to

diabetes regimen among respondents

Table 4.5         Health workers support towards adherence and non adherence

CHAPTER 1

INTRODUCTION

Diabetes Mellitus is a group of metabolic disorders in which the body has a deficiency of and/or a resistance to insulin (Jarrett, 2008). In 2003, 194 million people aged 20 to 79 years worldwide had diabetes, but it is expected to increase to 333 million by 2025, a 72% increase. In 2006, the developing countries accounted for 141 million people with diabetes (72.5%) of the total world, (Narayan et al., 2010.). According to the International Diabetes Federation, it is expected that the number of people with diabetes will double in three of the six developing regions: the Middle East and North Africa, South Asia and Sub-Saharan Africa. Type 2 diabetes mellitus accounts for approximately 85 to 95 percent of all diagnosed cases of diabetes, (International Diabetes Federation (IDF), 2010). In United States, more than 13.8 million Americans have diabetes and Type 2 diabetes accounts for 90% to 95% of the diagnosed cases with 800,000 new cases reported each year, (Silinik, 2007). In Australia, chronic diseases like diabetes now contribute to over 70% of the disease burden, and this is expected to increase to 80% by 2020 (Jordan et al., 2006). China with its large population of 1.3 billion has 30 million diabetic adults, while India has 35.5 million (Jordan et al., 2006).

Nigeria has 3.5% of its population as diabetic (Chinenye et al., 2008). In view of the rate at which diabetes is now increasing, especially in developing countries, and with its long and short term complications, there is urgent need for diabetic patients to adhere and maintain the American Diabetic Association’s Clinical Practice recommendations of tight plasma glucose control of 80–120mg/dl for fasting glucose measurement, eat as recommended, perform other self care activities, and go for check up as necessary(Motilch et al., 2006). Some studies, Rubin (2005), Kolyango (2008) and Dey (2008) have recorded prevalence of non adherence to various aspects of diabetes treatment.

Adherence has been defined as ‘the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes correspond with agreed recommendations from a health care provider (World Health organization (WHO), 2012).Adherence is also defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result” (Delamater, 2007). Though not perfect, the term ‘adherence’ is preferable to ‘compliance’, since the latter implies patient submission to the health care professional’s orders without mutual negotiation (Ahmadipour et al., 2010).

Patients’ non-adherence to therapeutic strategies is a serious concern that poses a great challenge to the successful delivery of healthcare. This is widespread and has been reported from all over the world (Shankar et al., 2013). Adherence to diabetes management includes adherence to medications, life style modification and dietary changes. It depends on healthcare system factors such as availability and ease of accessibility of the physician. Non-adherence may also be due to factors that are patient-centred such as age, gender, patient education etc or therapy-related such as route of administration, duration of treatment, complexity of treatment and the side effects of the medicines (Shankar et al., 2013).

Studies have been conducted worldwide and in Africa to establish factors associated with non-adherence to treatment amongst patients with type 2 diabetes mellitus (Ahmandipour et al., 2010 and Okolie et al., 2011) Nevertheless, there is paucity of studies on compliance to lifestyle recommendations. Amongst factors identified as responsible for poor adherence to the treatment of diabetes mellitus is a poor relationship between the healthcare provider and patient (Ciechanowski et al., 2010)  

1.1 Statement of the problem

Dietary adherence has always been a problem for both diabetics and physicians. Diabetics find it difficult to adhere to their diet due to poor understanding of the principles, strategies, priorities and method of diet therapy. Failure to individualize the diet to the patient’s cultural, sociological and economic background also poses a problem. Some patients also express strong feelings of independence and therefore do not like to be told what to eat and what not to eat. Some feel that it is too expensive to buy some foods. The degree of family support can be a problem.  Some families and friends bring them tempting food to eat and the elderly eat more food when with their friends than when alone. Deficiencies in patient education and follow up can be a problem. Poor relationship of patient and clinic can be a problem. Diabetes is a disease that virtually affects major organs in the body, resulting in complication that can be life threatening, it can be hereditary. These complications of diabetes are: neuropathy, erectile dysfunction, nephropathy, retinopathy ischemic heart disease, stroke and peripheral vascular disease) damage, with associated reduced life expectancy and diminished quality of life. Studies have emphasized the importance of achieving optimal glucose control through strict adherence to diet and exercise in order to minimize serious long-term complications (Anderson et al., 1993 and Mason et al., 1995).

In Federal Medical Centre (F.M.C) Umuahia, My clinical experiences show that patient with chronic conditions while receiving treatment in hospital most often developed complications showing that little information is available on treatment adherence. Regimen adherence problems are common in individuals with diabetes, making glycemic control difficult to attain. If diabetic management goals are to be achieved, all factors and circumstances that predispose or contribute to patients’ non adherence to regimen should be part of the health care givers’ concern(Okolie et al.,2012) Therefore, this work seeks to investigate whether there is adherence or non adherence to diabetes dietary regimen among patients with Type 2 diabetes in UNTH.

1.2 Objectives of the study

The overall objective of this study is to assess the level of adherence to diabetes dietary regimen among diabetic patients at University of Nigeria Teaching Hospital (UNTH). Specific objectives include; to

1.  Determine the level of adherence to diabetes dietary regimen among diabetic patients

2.  Establish the relationship between socio economic and demographic factors with adherence and non adherence to diabetes dietary regimen among diabetic patients.

3. Examine the influence of psychosocial factors towards adherence and non adherence to dietary regimen.

4.  Identify health workers support towards adherence and non adherence to dietary counselling.

1.3 Significance of the study

Identifying adherence and its factors w ill lead to finding more efficient and effective ways of enhancing patients’ adherence. It will also help healthcare providers compare their perceived factors related to patients’ live experiences thus enhancing patient/provider communication and better therapeutic relationship that aids adherence.

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