Academic journal article Journal of Health Population and Nutrition

Psychosocial Correlates of Dietary Behaviour in Type 2 Diabetic Women, Using a Behaviour Change Theory

Academic journal article Journal of Health Population and Nutrition

Psychosocial Correlates of Dietary Behaviour in Type 2 Diabetic Women, Using a Behaviour Change Theory

Article excerpt


Type 2 diabetes mellitus (T2DM) is a major global public-health challenge faced in the 21st Century (1). T2DM is the fourth or fifth leading cause of death in most developed countries, and there is a growing evidence that it has reached epidemic proportions in many developing and newly-industrialized countries (2).

Most studies have confirmed that changes in lifetyle can prevent its incidence, and proper control of blood glucose can reduce the risk of complications (3-5). Dietary management among patients with T2DM is one way to prevent or delay the long-term effect of the condition. Diabetic people are routinely advised to adopt a healthful diet; dietary changes include modifications in food habits and meal patterns on a lifelong basis (6,7). However, diet-related lifestyle behaviour is associated with very low compliance among the diabetics (8,9).

To develop effective dietary interventions for diabetic patients, it is necessary to understand the factors that determine eating behaviour in these populations. An understanding of such determinants enables the planning of health promotion interventions targeted at changing behaviour. Lifestyle behavioural change interventions are likely to be more successful when these focus on theory-based determinants (10).

Theory-based research is fundamental to the understanding of health behaviours by providing a framework by which to examine the relationships among constructs, to assess the impact of the various constructs, and to delineate factors and determinants to be studied (11-13).

There are several behaviour change models/theories. One is Aizen's Theory of Planned Behaviour (TPB). Since the earliest day of TPB, there has been a degree of uncertainty concerning between Aizen's perceived behavioural controls (PBC) and Bandura's self-efficacy (SE) construct. Both constructs concern the execution of a behaviour (14,15). On the other hand, Giles et al. (16) suggested that the predictive utility of the TPB may be enhanced by replacing PBC with self-efficacy.

Based on the above documents, we utilized Theory of Reasoned Action, along with self-efficacy (TRA+SE) to predict factors influencing dietary practice among type 2 diabetic women. This theoretical framework has proved its efficacy in predicting several health-related behaviours, including weight loss, smoking, alcohol-abuse, HIV risk behaviours, and mammography screening.

The Theory of Reasoned Action (TRA) is a widelyused behavioural prediction theory which represents a social-psychological approach to understanding and predicting the determinants of health-related behaviour (17,18). The TRA+SE model suggests that intention is directly driven by three major constructs: attitude, subjective norm, and self-efficacy; the stronger the intention, the more likely an individual will perform the behaviour (19). Attitude is known as the degree to which an individual has a favourable or unfavourable evaluation of the behaviour; subjective norm measures the importance others hold about performing or not performing a behaviour and one's willingness to comply with those referents; self-efficacy refers to an individual's confidence in his or her ability to perform a behaviour in various situations. Self-efficacy has been recognized as an important mediating variable between knowledge, attitudes, skills, and behaviour (20).

Self-efficacy is the focal belief on which human motivation and action is founded: unless a person believes he/she can produce desired effects by his/ her own actions, he/she has little incentive to act or to persevere in the face of difficulties. Highly-efficacious individuals tend to tackle more challenging tasks, employ better strategies, put forth more sustained effort, and be more persistent in the face of obstacles, setbacks, and difficulties (15,21,22). A self-efficacious individual persists because he/she believes he/she will eventually succeed. …

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