Document Type : Original Article


1 Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Departments of Health Education and Promotion and Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences


INTRODUCTION: Diet adherence may cause diabetes complications to be diminished.
OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with
Type 2 diabetes based on the health action process approach (HAPA).
METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran
health centers, were recruited during June–December 2018. The dietary regimen scale (nine items)
and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the
data. Data were analyzed using the Mann–Whitney test, Pearson Chi-squared test, Fisher’s exact
test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released
2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.).
RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated
with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear
regression showed that 55% of the variance of diet adherence was determined by HAPA variables.
Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers
(P = 0.003).
CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be
designed to promote diet adherence among the patients, especially those with low literacy and
patients living in poor communities.


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