title: Factors associated with nonadherence to diet and physical activity among Nepalese type 2 diabetes patients; a cross sectional study.
abstract: BACKGROUND
  Nonadherence to diet and physical activity is a major problem in the management of diabetes mellitus and its complications. This study was undertaken to measure the factors associated with nonadherence to diet and physical activity advice among Nepalese type 2 diabetic patients.
  
  
  METHODS
  An analytical cross-sectional study was conducted among type 2 diabetic patients (age, M ± SD, 54.4 ± 11.5 yrs) and interviewed using three days recall method for dietary history and Compendium of Physical Activity for physical activity. Data were analysed by univariate and multivariate statistics.
  
  
  RESULTS
  Out of 385 patients, 87.5% were nonadherent and 12.5% poorly adherent to dietary advice. 42.1% were nonadherent, 36.6% partially adherent while 21.3% good adherent to physical activity. Adherence to dietary advice was higher in males than females (M ± SD, 33 ± 16.7 vs 27 ± 15.5, p = 0.001), those staying nearer to hospital than farther (M ± SD, 32 ± 18.6 vs 28 ± 13.5, p = 0.013), those advice by physician than others (p = 0.001) and from nuclear family than joint and extended (p = 0.001). With increasing age, dietary advice adherence decreased (p = 0.06) and was positively correlated with the knowledge about diabetes mellitus (r = 0.115, p = 0.024). Physical activity adherence was higher in those with positive family history of diabetes than others (M ± SD, 74 ± 24.2 vs 65 ± 23.6, p = 0.001), upper middle socioeconomic class respondents than lower ones (p = 0.047) and from extended family than nuclear or joint ones (p = 0.041). Divorced were more nonadherent to physical activity than married and widowed patients (p = 0.021).
  
  
  CONCLUSIONS
  Determinants of nonadherence to dietary advice: Female gender, increasing age, joint or extended family members, farther distance from hospital, poor knowledge about diabetes mellitus and advice by others than physicians. Determinants for nonadherence to physical activity: negative family history of DM, divorced status, lower socioeconomic class.
authors.affiliation: Department of Community Medicine, Nepalgunj Medical College, Teaching Hospital, Koholpur, Banke, Nepal. meetjanaki@hotmail.com.
authors.forename: Janaki
authors.initials: J
authors.lastname: Parajuli
authors.forename: Farzana
authors.initials: F
authors.lastname: Saleh
authors.forename: Narbada
authors.initials: N
authors.lastname: Thapa
authors.forename: Liaquat
authors.initials: L
authors.lastname: Ali
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000628:therapy*; D004032:Diet; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009043:Motor Activity; D009390:Nepal; D010349:Patient Compliance