Identifying barriers and enablers in the Dietary Management of Type 2 Diabetes in Clinic Patients in M'Bour, Senegal

Background: In Sub-Saharan Africa (SSA) there is an increasing burden of type 2 diabetes. The treatment of diabetes requires lifestyle modifications such as a therapeutic diet. However, such recommendations are not always in keeping with local culture. Currently, there is limited information about the effect of culture on therapeutic diet adherence in SSA. This study seeks to identify potential cultural enablers and barriers to dietary management of type 2 diabetes in M’bour, Senegal.

 Methods: This qualitative study used the PEN-3 cultural model to explore diabetes dietary management within a cultural framework. Content analysis was conducted to identify emergent themes based on the PEN-3 model.

Results:  41 individuals (23 female, 18 male) completed the interviews (mean age= 58 years).  78.1% (n=32) reported concerns about food security. Culture affected adherence to the diabetic diet in several ways: 1) Having a different diet or eating separately from the communal family plate creates feelings of social isolation; 2) Forgoing the diabetic diet so that family members, especially children have enough food; 3) Reduced servings of traditional foods feels like abandoning culture and/or ‘punishment’; 4) Women are responsible for preparing food, however, men typically manage money for purchasing food, yet do not provide input on what food purchased. As a result, diabetic diets are best managed in families where men and women are knowledgeable about the diet and participate in joint dietary decision-making.

Conclusions: Results suggest that educating family units on the dietary management of diabetes may be more effective than individual education.