PERCEIVED IMPACT AND CHALLENGES OF COMPLIANCE WITH DIABETIC DIET AMONG PATIENTS ATTENDING A DIABETIC CLINIC IN EDO SPECIALIST HOSPITAL, BENIN CITY

TOPIC: PERCEIVED IMPACT AND CHALLENGES OF COMPLIANCE WITH DIABETIC DIET AMONG PATIENTS ATTENDING A DIABETIC CLINIC IN EDO SPECIALIST HOSPITAL, BENIN CITY

THIS TOPIC IS ALSO SUITABLE FOR:
1-Department of Nursing Science
2-Department of Public Health
3-Department of Nutrition and Dietetics
This research material contains:
1-Chapter One to Five
2-Recent References/citations
3-Tables/Charts/Graphs in Chapter Four
4-Accurate Data Analysis
5-Table of Contents
6-Questionnare

ABSTRACT
This study was carried out to assess the perceived impact and challenges of compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City. The study was specifically carried out to determine the level of compliance with the recommended diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, assess the perceived impact of compliance with diabetic diet on the health outcomes of patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, identify the factors influencing compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, and examine the challenges associated with compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City. The study employed the descriptive survey research design. The study population comprised 232 adult diabetic patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, while a total of 147 respondents were selected as sample size using the Taro Yamane formula. Out of the 147 questionnaires distributed, 141 were returned and 141 were validated for analysis. The questionnaire was used for data collection, while the data collected were analyzed using frequency tables and simple percentages with the aid of SPSS version 25. On the other hand, the hypothesis was tested using Chi-square. From the responses obtained and analyzed, the findings revealed that respondents demonstrated a high level of compliance with the recommended diabetic diet, with the majority consistently adhering to prescribed meal plans, recommended meal timing, portion control, healthy food choices, and dietary instructions provided during clinic visits. The study also showed that respondents perceived compliance with diabetic diet as contributing positively to improved blood sugar control, better general wellbeing, maintenance of healthy body weight, increased energy levels, reduced diabetes-related complications, and improved quality of life. Likewise, the findings revealed that dietary knowledge, family support, income level, dietary counselling by healthcare professionals, availability of healthy foods, and personal motivation were the major factors influencing compliance with diabetic diet, while the high cost of healthy foods, cultural food preferences, busy daily schedules, limited availability of recommended foods, social gatherings, and cravings for favourite foods constituted the major challenges associated with dietary compliance. The study concluded that patients attending the diabetic clinic at Edo Specialist Hospital generally demonstrated satisfactory compliance with recommended diabetic diets and acknowledged the positive impact of dietary adherence on their health outcomes despite experiencing several socioeconomic, behavioural, and environmental challenges. The study therefore recommends that healthcare professionals should strengthen individualized nutritional counselling during clinic visits, government and hospital management should improve access to affordable healthy foods for diabetic patients, family members should actively support patients in maintaining recommended dietary practices, and patients should adopt practical meal-planning strategies that promote long-term dietary compliance.
Keywords: Diabetic Diet, Dietary Compliance, Health Outcomes, Diabetes Mellitus, Dietary Challenges, Edo Specialist Hospital.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background to the Study
In many countries around the world, diabetes mellitus is now one of the most important chronic non-communicable diseases, with critical impact on the health and wellbeing of individuals and on healthcare systems and socioeconomic development. Besides medical therapy, maintaining good glycemic control requires constant compliance to the recommended lifestyle changes, especially the food plan. Diabetic diet compliance is the degree to which a patient follows their personalized dietary instructions for better glycaemic control, healthy body weight and to minimize acute and chronic complications. Following dietary recommendations is a cornerstone of diabetes management, directly impacting blood glucose management and metabolic outcomes (Mohammed et al., 2020). Likewise, Bekele et al. (2020) suggested that dietary intervention is still one of the most cost-effective methods of slowing the progression of diabetes and enhancing the quality of life of people living with type 2 diabetes. Building on this understanding, Wilson et al., (2024) pointed out that dietary adherence is not something that is necessarily just expected as a clinical outcome but rather a behavioural process influenced by individual, cultural and environmental factors. Similarly, Deslippe et al. (2023) stated that maintaining adherence to recommended dietary guidelines is linked to improved lifestyle habits and enhanced long-term disease management in diabetic patients.
Given the importance of nutrition in diabetes management, a growing interest has emerged in the degree of adherence to the diet among patients with diabetes and the health benefits that are linked to compliance. Adhering to diabetic nutritional guidelines has been linked to better glycaemic control, nutrition, metabolic stability, and lowered risk of diabetes complications. In a study conducted by Mohammed et al. (2020), it was found that patients who followed the dietary advice more were more likely to have good glycaemic control, as those who followed the advice less. In this line, Abose et al. (2024) found that follow-up of the recommended diets is a key factor for good clinical results among those under regular diabetic treatment. In addition, Molavynejad et al. (2022) showed that structured dietary education had a significant effect on patients' adherence to the dietary plan, which is a positive effect on health. Similarly, Ayeni et al. (2025) validated the role of educational dietary interventions in reinforcing patients' knowledge of healthy food choices and facilitating adherence to prescribed dietary plans, which can lead to better diabetes self-management and overall wellbeing.
As evidence continues to demonstrate the benefits of dietary adherence, contemporary research has increasingly focused on the factors that influence patients' ability to comply with recommended diabetic diets. Compliance is now known to be a multi-faceted behavior that is greatly affected by personal knowledge, food literacy, health beliefs, self-efficacy, social support, educational experiences, and health care advice. Uwuma (2023) has found that there is a strong correlation between food literacy and dietary compliance, indicating that patients with a higher level of food literacy can better practice the dietary recommendations. To support this, Xie et al. (2020) suggested that the link between socio-demographic attributes and diabetes self-management behaviour (DMSB) is mediated by health attitudes and self-efficacy. In the same vein, Uthman-Akinhanmi et al. (2024) insisted that patients' knowledge and behavioural skills play a significant role in their nutritional status and effective blood sugar self-management. Moreover, Luka et al. (2025) underscored the importance of building awareness and knowledge about diabetes management, as this boosts adherence to dietary and activity guidelines. These perspectives as a whole suggest that dietary adherence is more than just advice on diet and nutrition, but instead a combination of cognitive, behavioural and social factors that influence patients' daily health choices.
Therefore, apart from the measurable health benefits of adherence to a recommended diet and the various behavioural determinants that influence adherence, studies have explored what patients experience when it comes to the practicalities of following a recommended diabetic diet in the various healthcare contexts. Various studies have been done in Africa and in other parts of the world, to understand patients' perception of the effect of complying with the diet, in addition to the real-life situation people face when it comes to their diet. Adaptability to nutrition recommendations in patients' daily lives and social contexts is the key to coping with dietary complexity, as described by Tang and Yang (2025). In the same way, Tuobenyiere et al. (2023) highlighted the importance of understanding patients' experiences to better understand diabetes self-management and food choices. Desse et al. (2024) further pointed out that the patient-perceived experiences add to the understanding of self-management practices in sub-Saharan Africa and provide insight into what it is like to live with the disease. Studies conducted in the Nigerian environment have shown that lifestyle modifications and dietary adherence are key considerations for diabetes management of clinic attendees (Akadri and Akadri, 2021 and Olonisakin et al., 2022). In this context, an investigation into the perception of the effect and problems of diabetic diet adherence among patients at the diabetic clinic in Edo specialist hospital, Benin City, is useful for understanding the situation of diabetic diet adherence in the tertiary health care setting and adds to the context-specific evidence relevant to diabetic diet adherence in Edo state, Nigeria.

1.2 Statement of the Problem
While it is known that diet is one of the fundamental aspects of diabetes management, recent studies have shown that many people with type 2 diabetes do not follow the prescribed dietary measures consistently. The target would be that diabetic people who are attending the follow-up clinic, should be able to adhere to the dietary advice given and should ensure good glycaemic control, prevention of diabetic complications and good quality of life. But more recent research has shown that non-adherence to diet is prevalent in various healthcare settings. For example, Abebe et al. (2023) found that diabetic patients were not following the recommended diet and Wilson et al. (2024) also found that of patients even after attending the clinic regularly and being counselled on nutrition. Similarly, Armah et al. (2025) found a high level of non-adherence to diet among PLWD and Atosona et al. (2024) found that dietary non-adherence is affected by several personal and contextual factors. This is a problem because it reduces the effectiveness of comprehensive management programmes and the patients' ability to reach expected therapeutic outcomes, and shows the importance of knowing patients' dietary compliance behaviours and what they perceive about their diet.
Existing studies have substantially contributed to knowledge on dietary adherence by examining adherence levels, determinants, barriers, educational interventions, and self-management practices among diabetic patients in different countries and selected regions of Nigeria (Bekele et al., 2020; Olonisakin et al., 2022). Likewise, the perceived barriers to adherence to the diet (Alrasheeday et al., 2024; Tariq et al., 2025), food literacy and compliance with the diet (Uwuma, 2023) and strategies to improve adherence through educating patients (Ayeni et al., 2025; Molavynejad et al., 2022) have been discussed. There has been however a scanty empirical focus on incorporating the extent of patients' dietary compliance, perceived health consequences of dietary compliance, factors that affect dietary compliance and practical problems within the framework of Edo Specialist Hospital, Benin city. Therefore, the evidence in this healthcare context is still lacking in terms of being context-specific and reflecting experiences of patients. This study therefore, aims at addressing this gap in knowledge by finding out the extent of adherence to recommended diabetic dietary regimen, the perceived effect of adherence on the health outcome of the patients, factors that affect adherence to diabetic diet and the difficulties faced in compliance with the diabetic diet among patients that attend the diabetic clinic at Edo Specialist Hospital, Benin City.
1.3 Objectives of the Study
The broad objective of this study is to examine the perceived impact and challenges of compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City. The specific objectives are to:
1.Determine the level of compliance with recommended diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City.
2.Assess the perceived impact of compliance with diabetic diet on the health outcomes of patients attending the diabetic clinic at Edo Specialist Hospital, Benin City.
3.Identify the factors influencing compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City.
Examine the challenges associated with compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City.
Other parts of chapter one include:
1.4 Significance of the Study
1.5 Scope of the Study
1.6 Research Questions
1.7 Hypothesis
1.8 Significance of the Study
1.9 Scope of the Study
1.10 Operational Definition of Terms

CHAPTER TWO
LITERATURE REVIEW (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of diabetes mellitus, the concept of diabetic diet, compliance with diabetic diet, perceived impact of compliance with diabetic
diet, challenges associated with compliance with diabetic diet, and factors influencing compliance with diabetic diet among patients etc. The chapter is sub-grouped into the following major headings:
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
METHODOLOGY (Preview)
Presented below is a snapshot of key areas of the study methodology, the full and detail chapter three methodology is contained in the instant download document.

Research Design: The study adopted a descriptive survey research design.
Population of the Study: The population of the study comprises all adult diabetic patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, Edo State, with a total population of registered diabetic patients.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 147 participants.
Sampling Technique: The study employed a simple random sampling technique to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire titled "Perceived Impact and Challenges of Compliance with Diabetic Diet Questionnaire (PICCDDQ)" as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their responses. Inferential statistics, such as Chi-square, were used to test the hypothesis.
Full outline for chapter three;
3.1 Research Design
3.2 Research Setting
3.3 Target Population
3.4 Sample Size
3.5 Sampling Technique
3.6 Instrument for Data Collection
3.7 Validity and Reliability of the Instrument
3.8 Pilot Study
3.9 Method of Data Collection
3.10 Method of Data Analysis
3.11 Ethical Consideration

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables and charts. Based on the results obtained from the analysis, the following major findings were made:

i. The study found that patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, generally exhibit a high level of compliance with recommended diabetic diet, as evidenced by the majority acceptance of all six items analyzed, with agreement responses ranging from 77.3% to 80.8%. This indicates that patients generally adhere to prescribed meal plans, maintain recommended portion sizes, avoid foods with high sugar content, observe appropriate meal times, make healthy food choices, and follow dietary recommendations provided during clinic visits.

ii. The study found that compliance with diabetic diet is widely perceived to have a positive impact on the health outcomes of patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, as evidenced by the majority acceptance of all six items analyzed, with agreement responses ranging from 82.3% to 85.1%. This implies that dietary compliance improves blood sugar control, enhances general wellbeing, helps maintain healthy body weight, reduces diabetes-related complications, increases daily energy levels, and improves overall quality of life. The corresponding hypothesis test produced a Chi-square (χ²) value of 28.47, with 4 degrees of freedom and a p-value of 0.001 (p < 0.05), leading to the rejection of the null hypothesis. This indicates that compliance with diabetic diet has a statistically significant impact on the health outcomes of patients.

iii. The study found that knowledge of diabetic diet, family support, income level, dietary counselling from healthcare professionals, availability of healthy foods, and personal motivation are the major factors influencing compliance with diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, as evidenced by the majority acceptance of all six items analyzed, with agreement responses ranging from 81.5% to 83.7%.

iv. The study found that the high cost of healthy foods, cultural food preferences, busy daily schedules, limited availability of recommended foods, social gatherings, and cravings for favourite foods are the major challenges associated with compliance with recommended diabetic diet among patients attending the diabetic clinic at Edo Specialist Hospital, Benin City, as evidenced by the majority acceptance of all six items analyzed, with agreement responses ranging from 81.5% to 84.4%.

CHAPTER FIVE: DISCUSSION OF FINDINGS
This chapter covers the following outline:
5.1 Discussion of Findings
5.2 Implications of the Study
5.3 Limitations of the Study
5.4 Contributions to Knowledge
5.5 Summary of the Study
5.6 Conclusion
5.7 Recommendations
5.8 Suggestions for Further Studies
Reference
Appendix

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