title: Determinants of dietary self-care behaviours among Taiwanese patients with type 2 diabetes.
abstract: 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.
authors.affiliation: Department of Dietetics, National Taiwan University Hospital, Taipei, Taiwan, ROC.|The Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Chung-Mei
authors.initials: CM
authors.lastname: Ouyang
authors.affiliation: The Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA. Email: dwyerj1@od.nih.gov.
authors.forename: Johanna T
authors.initials: JT
authors.lastname: Dwyer
authors.affiliation: The Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
authors.affiliation: The Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Haas
authors.affiliation: Section on Behavioural and Mental Health Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000523:psychology; D004032:Diet / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013624:Taiwan