Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study.

BACKGROUND: Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D. METHODS: A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence. RESULTS: Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment). CONCLUSION: The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.

Challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries: A systematic review.

BACKGROUND: Access to high quality research literature is essential for educating nursing and healthcare students to promote evidence-based practice. Within Low- and Middle-Income countries (LMICs) access is limited due to financial and structural constraints within countries and institutions. Reduced access to research literature limits the achievement of the Sustainable Development Goals through its impact on the education of healthcare staff and on the development of contextually appropriate evidence for practice. OBJECTIVE: To identify the challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries. DESIGN: Systematic review. DATA SOURCES: Searches were conducted in MEDLINE, CINAHL PLUS, ERIC, ASSIA, EMBASE, and Google Scholar. REVIEW METHODS: Five bibliography databases were searched using relevant search terms, from January 2002 to July 2022. Additional searches were carried out in Google Scholar. Titles, abstracts, and full texts were independently screened by at least two authors, based on predefined eligibility criteria. Pertinent data were extracted from included studies, and critical appraisal was undertaken. Data were analysed and presented in a narrative approach. RESULTS: Five papers met the inclusion criteria and were included. Three aspects of challenges at different levels emerged: infrastructure and institutional level factors, individual factors, and lack of contextually appropriate evidence. Three solutions were identified: capacity development opportunities, improving Internet access, and increasing awareness of free resources. CONCLUSION: This review provides an overview of common barriers medical and nursing professionals and students encounter whilst accessing scholarly literature in LMICs and identifies some possible solutions to address them. The findings can be used to guide institutions, as well as national and international decision makers to elicit policy which can promote the uptake of research in LMICs. Further research should focus on how these solutions could be harnessed to address the problems identified in this review.