Predictors of Healthy Diet Adherence Intention Among Type 2 Diabetes Patients in Public Hospitals of Dire Dawa, Eastern Ethiopia:

A Theory of Planned Behavior Approach

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is an increasing public health problem in Ethiopia and globally, with poor dietary adherence posing a major challenge to effective disease management. Although dietary modification is a cornerstone of diabetes care, many patients fail to adhere to recommended dietary practices. Understanding the determinants of dietary intention is therefore essential. The Theory of Planned Behavior (TPB) provides a robust framework to examine psychological and behavioral factors influencing intention to adhere to a healthy diet among patients with T2DM attending public hospitals in Dire Dawa, Eastern Ethiopia.

Methods: A facility-based cross-sectional study was conducted from March to April 2025 among 422 systematically selected T2DM patients attending Dilchora and Sabian public hospitals. Data were collected using a structured TPB-based questionnaire and analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were performed, and associations were reported using adjusted odds ratios (AOR) with 95% confidence intervals (CI).

Results: Overall, 51.4% of participants had good intention to adhere to a healthy diet, while 73% demonstrated low actual dietary adherence. Significant predictors of good intention included female sex (AOR=2.40, 95% CI: 1.35, 4.26), urban residence (AOR=0.51, 95% CI: 0.27, 0.95), regular physical exercise (AOR=0.47, 95% CI: 0.24, 0.92), positive attitude (AOR=3.44, 95% CI: 1.59, 7.46), strong behavioral belief (AOR=7.93, 95% CI: 3.31, 19.01), and high perceived control (AOR=7.92, 95% CI: 2.61, 23.99).

Conclusion: Although intention to adhere to a healthy diet was moderate, actual dietary adherence was low. Interventions should strengthen TPB constructs particularly attitude, behavioral beliefs, and perceived control to effectively translate intention into sustained dietary behavior.