Dietary self-care and associated factors among diabetic patients in Jimma University Medical Centre, South West Ethiopia; A path analysis

Background Diabetes Mellitus (DM), a chronic metabolic disorder that caused about 4.2 million deaths and at least 760 billion dollars' expenditure in 2019, has been targeted for action by leaders of WHO member countries. In Ethiopia deaths, due to DM reached 34,262 in 2013. Studies show effective lifestyle interventions; particularly medical nutrition therapy reduces HbA1c by 0.5 to 2%. However, practicing recommended diet is reported to be difficult. Not only Knowledge and practice but also perception studies are therefore necessary to design future health programs. Objective To assess diabetic self-care, dietary practice and associated factors among diabetes patients. Method Institution-basedbased cross-sectional study design was employed from february15-May15, 2020 in Jimma university medical Centre (JUMC). Systematic sampling of every other patient (K = 2.7) was employed to interview 371 participants. A previously validated tool was used to collect data through a face-to-face interview. A path analysis was used to fit the structural model and tests the hypothesized Health Belief Model (HBM) relationships. Result Response rate was 95.4% (354). Around 52% of the participants were male and 76.8% follow diabetic education at least some times. 42.4% and 48% of respondents have good dietary and general self-care practices respectively. With unstandardized coefficient (standard error) self-efficacy0.10 (0.01) being the strongest cues to action0.10 (0.02), perceived threat0.02 (0.01), and perceived barrier-0.08(0.01) constructs of HBM have a significant effect on dietary practice. Knowledge, social support and diabetes distress exert a significant indirect effect on dietary practice through health belief constructs with unstandardized path coefficient (standard error) of 0.22(0.03), 0.02(0.01), and -0.03(0.004) respectively. Conclusion In this study, the proportion of good practice is found to be lower for both dietary as well as general self-care. HBM can best fit to explain variability in dietary self-care practice; therefore, future interventions should be designed to address the vast perception and psychosocial factors influencing dietary self-care practices.