Dietary Non-adherence and Associated Factors among Adults with Type 2 Diabetes in Ethiopia: A Sequential Explanatory Mixed- Methods Study
This sequential explanatory mixed-methods study conducted in Ethiopia reveals that nearly 69% of adults with Type 2 diabetes are non-adherent to dietary recommendations, a high rate driven by significant barriers including household food insecurity, poor dietary knowledge, lack of family support, and economic constraints.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Diabetes is a condition where the body struggles to manage sugar in the blood, a problem that can quietly damage the heart, eyes, and kidneys over time. While medicine plays a role in keeping this condition in check, doctors have long known that what a person eats is just as critical. For someone with type 2 diabetes, the goal is to follow a specific eating plan that avoids foods high in sugar and fat while focusing on vegetables, whole grains, and lean proteins. This approach can lower blood sugar levels and prevent the serious complications that often shorten lives. However, knowing what to eat is different from actually doing it. In many parts of the world, including Ethiopia, the gap between medical advice and daily reality is wide. People face real-world hurdles like the cost of fresh food, the habits of their families, and the difficulty of changing a lifetime of eating patterns. Understanding why people struggle to follow these diets is essential if health systems are to help them stay healthy.
Researchers in Shaggar City, Ethiopia, set out to understand exactly why so many adults with type 2 diabetes are not following the dietary advice given to them. They conducted a study involving nearly six hundred patients visiting public health centers. The team first asked these patients a series of questions about their eating habits, their knowledge of nutrition, their family life, and their financial situation. To get a deeper sense of the personal stories behind the numbers, the researchers then sat down for long, detailed conversations with a smaller group of patients. They wanted to hear directly from the people themselves about the barriers they faced when trying to eat the right foods.
The results painted a clear and concerning picture. The study found that nearly seven out of ten patients were not adhering to the recommended dietary plans. This means that for the vast majority of these individuals, the advice to eat more vegetables and fewer sugary foods was not being followed in their daily lives. The researchers identified several specific reasons for this high rate of non-adherence. One of the strongest factors was the lack of money to buy food. Many patients lived in households where there was simply not enough food to go around, let alone the specific, often more expensive, foods recommended for diabetes. When inflation drove up the price of basic items like onions or vegetables, patients felt they had no choice but to eat whatever was cheap and available, even if it was unhealthy for their condition.
Beyond money, the study highlighted the powerful role of family and knowledge. Patients who did not feel supported by their families were much less likely to stick to their diets. In many homes, everyone ate the same meal, and a patient could not easily separate their plate from the rest of the family's food. If a family member insisted on eating together or if social gatherings demanded certain foods, the patient often gave in to avoid conflict or isolation. Furthermore, many patients simply did not understand the details of what they should eat. Even when they received advice from doctors, they often found it confusing or too abstract to apply to their daily cooking. The study showed that patients who had been diagnosed with diabetes for less than five years were particularly struggling, likely because they had not yet had enough time or practice to build new, healthy habits.
The researchers also looked at how health education was delivered and found that the method mattered. Patients who received only verbal advice were less likely to follow the rules than those who were given printed materials or saw videos and pictures explaining the diet. The study suggests that seeing information in a tangible form helps people remember and understand it better. Interestingly, the study found that patients who were already overweight or had a healthy weight were actually more likely to follow the diet than those who were obese. This suggests that the physical struggle of carrying excess weight might be linked to a greater difficulty in changing eating habits, or perhaps that those who are already at a healthy weight have more motivation to stay that way.
The conversations with the patients revealed the emotional weight of these struggles. Many described the diabetic diet as a "luxury" they could not afford. One patient explained that when the price of a single kilogram of onions rose, it became impossible to buy the vegetables needed for a healthy meal. Others spoke of the loneliness of trying to eat differently from their family, noting that eating alone felt like a form of social death. The study did not find that a lack of willpower was the main issue; rather, it showed that the environment itself was working against the patients. Financial constraints, rising food prices, a lack of clear information, and the pressure of family dynamics created a perfect storm that made following a healthy diet nearly impossible for most.
Ultimately, this research tells us that telling a patient to "eat better" is not enough when the world around them makes it difficult to do so. The high rate of non-adherence is not a failure of the patients, but a reflection of the economic and social realities they face. The study concludes that to help these patients, health programs need to go beyond simple advice. They need to address the cost of food, provide clear and visual educational materials, and involve families in the process so that the home environment supports, rather than hinders, the patient's health. Without addressing these deeper issues, the gap between medical advice and daily life will remain too wide to cross.
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