Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation

• DOI: 10.1371/journal.pone.0214142
• Publication Date: 2019-03-25T17:33:19Z
• Authors: Lizzie Caperon; Abriti Arjyal; Puja K. C.; Jyoti Kuikel; James Newell; Remco Peters; Andrew Prestwich; Rebecca King
• Keywords: Adult; Blood Glucose; Male; 0301 basic medicine; Urban Population; Science; Health Behavior; 610; /dk/atira/pure/core/keywords/exercise_nutrition_and_health_sciences; 613; Nutrition and Health Sciences; Models, Biological; 03 medical and health sciences; Nepal; 11. Sustainability; Diabetes Mellitus; /dk/atira/pure/core/keywords/exercise_nutrition_and_health_sciences; name=SPS Exercise, Nutrition and Health Sciences; Humans; name=SPS Exercise; 360; 2. Zero hunger; Q; R; 1. No poverty; Feeding Behavior; Middle Aged; 3. Good health; Socioeconomic Factors; Medicine; Female; Research Article

Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals' motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes.