The Effect of Educational Intervention on Dietary Adherence among Type 2 Diabetics in Zahedan: Using the Health Action Process Approach

Abstract

Abstract Objective: Type 2 diabetes is the most common type of diabetes, accounting for the majority of cases. Self-care practices among type II diabetics improve the quality of life and reduce treatment costs. Dietary adherence is one of the self-care practices. This research was conducted with the aim of using the HAPA model to improve dietary adherence among type 2 diabetics in Zahedan. Methods: In this cross-sectional study, 210 type-2 diabetic patients admitted to hospital clinics in Zahedan during the summer of 2022 were selected (code: IR.ZAUMS.SPH.REC.1400.392). The clinics were selected by coin flipping. The intervention group (105 people) was from the diabetes clinic at Bu Ali Hospital, and the control group (105 people) was from the diabetes clinic at Khatam Al-Anbia Hospital in Zahedan. Sampling was done by simple random sampling among the diabetic patients. After collecting the data using the demographic characteristics questionnaire and the standard questionnaires, i.e., the Dietary Adherence Questionnaire and HAPA model constructs questionnaire, the pre-test analysis was done. Then the four-session educational intervention was conducted in the form of lectures, educational booklets, and behavior self-report booklets. One and three months after the educational intervention, the questionnaires on HAPA model constructs and self-care behavior were filled out by the patients and collected for analysis. Data were analyzed using independent t, chi-square, and Shapiro-Wilk tests in SPSS version 23 software. Findings: The results showed that all the HAPA model constructs, including risk perception, outcome expectancies, behavioral intention, action self-efficacy, coping self-efficacy, recovery self-efficacy, action planning and coping planning, perceived barriers, perceived benefits, and self-care behavior had significant differences in one month and three months after the educational intervention (P = 0.001), which indicated the effectiveness of education in the intervention group. However, there was no significant difference in the control group (P = 0.009). Discussion and conclusion:The intervention using the HAPA model showed that after the training, the model constructs had a significant impact on the patients' self-care regarding dietary adherence. Appropriate programs with details on action planning and coping planning should be developed to promote dietary adherence among patients with type 2 diabetes.