title: Factors associated with diet barriers in patients with poorly controlled type 2 diabetes.
abstract: BACKGROUND
  The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables.
  
  
  METHODS
  Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers.
  
  
  RESULTS
  Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by "eating away from home" (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (β=-0.282, P<0.001) and empowerment (β=-0.190, P=0.015), and more negative appraisal (β=0.225, P=0.003).
  
  
  CONCLUSIONS
  Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong.
authors.forename: Li
authors.initials: L
authors.lastname: Cheng
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong.
authors.forename: Doris Yin-Ping
authors.initials: DY
authors.lastname: Leung
authors.affiliation: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong.
authors.forename: Janet Wing-Hung
authors.initials: JW
authors.lastname: Sit
authors.affiliation: The Department of Nursing, Faculty of Medicine, The Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Li
authors.affiliation: The Department of Endocrinology, The Ninth Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wu
authors.affiliation: The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Miao-Yan
authors.initials: MY
authors.lastname: Yang
authors.affiliation: The Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Cui-Xia
authors.initials: CX
authors.lastname: Gao
authors.affiliation: The Department of Endocrinology, Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China.
authors.forename: Rong
authors.initials: R
authors.lastname: Hui
keywords: appraisal; diabetes; diet barriers; empowerment; knowledge
references.citation: Diabetes Care. 1995 Jul;18(7):943-9
references.pmid: 7555554
references.citation: Diabet Med. 2009 May;26(5):510-7
references.pmid: 19646191
references.citation: Diabet Med. 2015 Jan;32(1):133-40
references.pmid: 25131861
references.citation: Psychol Health. 2013;28(1):103-19
references.pmid: 22924481
references.citation: Osong Public Health Res Perspect. 2014 Aug;5(4):199-203
references.pmid: 25379370
references.citation: Diabet Med. 2010 Apr;27(4):442-50
references.pmid: 20536517
references.citation: Ann Behav Med. 2014 Apr;47(2):242-8
references.pmid: 24114328
references.citation: Can Fam Physician. 2008 Feb;54(2):219-27
references.pmid: 18272638
references.citation: Adv Nutr. 2013 May 01;4(3):277-86
references.pmid: 23674793
references.citation: Health Expect. 2014 Jun;17(3):303-10
references.pmid: 22212306
references.citation: J Behav Med. 1991 Feb;14(1):43-51
references.pmid: 2038044
references.citation: Nurse Pract. 2013 Apr 10;38(4):42-8
references.pmid: 23507913
references.citation: Diabetes Care. 2012 Jun;35(6):1364-79
references.pmid: 22517736
references.citation: Diabetes Care. 2014 Jan;37 Suppl 1:S14-80
references.pmid: 24357209
references.citation: J Diabetes Complications. 2010 Mar-Apr;24(2):84-9
references.pmid: 19282203
references.citation: Patient Prefer Adherence. 2014 Jul 24;8:1019-24
references.pmid: 25092966
references.citation: BMC Fam Pract. 2012 Dec 19;13:122
references.pmid: 23249410
references.citation: Patient Prefer Adherence. 2014 Feb 14;8:219-26
references.pmid: 24627626
references.citation: J Cardiovasc Nurs. 2012 May-Jun;27(3):253-62
references.pmid: 21760521
references.citation: Diabetes Res Clin Pract. 2011 Mar;91(3):321-32
references.pmid: 21215487
references.citation: Diabetol Metab Syndr. 2013 Oct 24;5(1):57
references.pmid: 24228724
references.citation: Gerontologist. 2013 Aug;53(4):676-86
references.pmid: 23070934
references.citation: J Diabetes. 2012 Sep;4(3):243-7
references.pmid: 22221835
references.citation: N Engl J Med. 2012 Mar 1;366(9):780-1
references.pmid: 22375967
references.citation: Patient Educ Couns. 2013 Jan;90(1):4-11
references.pmid: 23063359
references.citation: J Diabetes Metab Disord. 2013 Jan 19;12(1):6
references.pmid: 23497631
references.citation: Diabet Med. 2009 Jan;26(1):5-13
references.pmid: 19125754
references.citation: Rev Diabet Stud. 2006 Spring;3(1):11-6
references.pmid: 17491707
references.citation: Diabetes Res Clin Pract. 2011 Jul;93(1):1-9
references.pmid: 21382643
references.citation: Diabet Med. 2013 Apr;30(4):413-20
references.pmid: 23278342
references.citation: Nurs Health Sci. 2010 Jun;12(2):259-67
references.pmid: 20602700
references.citation: Maturitas. 2014 Nov;79(3):292-8
references.pmid: 25096829
references.citation: Am Psychol. 2010 Oct;65(7):646-59
references.pmid: 20873882
references.citation: J Psychosom Res. 2014 Apr;76(4):265-74
references.pmid: 24630175
references.citation: Gen Hosp Psychiatry. 2012 Jul-Aug;34(4):385-9
references.pmid: 22554428
references.citation: Diabetes Care. 2003 May;26(5):1641-2
references.pmid: 12716841
references.citation: J Clin Nurs. 2012 Feb;21(3-4):301-10
references.pmid: 22175249
references.citation: J Epidemiol Community Health. 2014 Jun;68(6):557-64
references.pmid: 24489044
references.citation: Stress Health. 2012 Apr;28(2):111-22
references.pmid: 22282035
references.citation: Diabet Med. 2015 Oct;32(10):1297-303
references.pmid: 25683652
references.citation: Diabet Med. 2005 Jan;22(1):32-8
references.pmid: 15606688
references.citation: Int J Obes (Lond). 2012 May;36(5):665-74
references.pmid: 21829162
references.citation: Diabetes Educ. 2007 Nov-Dec;33(6):1080-103; discussion 1104-6
references.pmid: 18057276
references.citation: Nat Rev Endocrinol. 2011 Nov 01;7(12):691
references.pmid: 22045108
references.citation: Public Health Nutr. 2013 Dec;16(12 ):2105-13
references.pmid: 23182344
references.citation: Diabetes Ther. 2011 Mar;2(1):9-19
references.pmid: 22127765
references.citation: J Diabetes Sci Technol. 2013 Jan 01;7(1):111-8
references.pmid: 23439166
references.citation: Diabetes Res Clin Pract. 2013 Feb;99(2):174-84
references.pmid: 23273515
references.citation: Patient Prefer Adherence. 2009 Nov 03;3:123-30
references.pmid: 19936154
references.citation: Prim Care Diabetes. 2015 Jun;9(3):219-25
references.pmid: 25457433
references.citation: Diabetes Educ. 2007 Jul-Aug;33(4):680-90
references.pmid: 17684169
references.citation: Diabetes Res Clin Pract. 2011 Jan;91(1):40-6
references.pmid: 21040993
references.citation: Qual Health Res. 2012 Jan;22(1):103-18
references.pmid: 21876206