Bridging the Compliance Gap: An Assessment of Dietary andPhysical Activity Adherence Among Type 2 Diabetes Patients inKericho County, Kenya

Abstract

Adherence to lifestyle modification recommendations plays a significant role in the management of diabetes mellitus, which commonly affects elderly groups. Low or nonadherence to dietary and physical activity recommendations is a major problem that retrogresses efforts invested in diabetes care and management. This subject is underexplored in Kenya, with no existing study conducted in Kericho County. The study is aimed at bridging the existing compliance gap through assessment of dietary and physical activity adherence among Type 2 diabetes patients aged 40+ years in Kericho County, Kenya. A hospital-based cross-sectional study involving 207 type 2 diabetes patients at Kericho County Referral Hospital using a pretested and structured interviewer-administered questionnaire was conducted. Validated and customized perceived dietary adherence questionnaire (PDAQ) and global physical activity questionnaire (GPAQ) were utilized. Data on sociodemographic and behavioral characteristics, and diet and exercise were collected from selected respondents through systematic random sampling technique. Collected data were analyzed using SPSS Version 26. Bivariate and multivariate logistic regression was performed to identify factors influencing adherence, with significance set at < 0.05. Results showed that 51.7% and 35.3% of the respondents were adherent to recommended dietary and physical activity, respectively. Being aged ≥ 70 years (AOR = 2 13, 95% CI: 1.01– 4.87, p = 0 02), postprimary education (AOR = 1 71, 95% CI: 1.39–5.28, p = 0 02), absence of comorbidities (AOR = 1 68, 95% CI: 1.33–1.08, p = 0 01), and absence of complications (AOR = 1 57, 95% CI: 1.32–1.96, p = 0 03) had higher likelihood of adherence to dietary recommendations. Unmarried patients (AOR = 0 22, 95% CI: 0.07–0.68, p = 0 008) and lack of family support (AOR = 0 51, 95% CI: 0.31–0.91, p = 0 01) were significantly associated with lower adherence to dietary recommendations. Higher odds of physical activity adherence were associated with postprimary education (AOR = 1 75, 95% CI: 1.27–3.18, p = 0 03) and diabetes duration of > 10 years (AOR = 1 52, 95% CI: 1.03–2.13, p = 0 04), while lower among patients aged ≥ 70 years (AOR = 0 64, 95% CI: 0.29–0.87, p = 0 02) and lacked family support (AOR = 0 54, 95% CI: 0.37–0.85, p = 0 04). These findings underscore urgent need for targeted and context-specific tailored health education, promotion of family support and involvement, and designing of individualized lifestyle modification plan that integrated functional disparities for sustainable adherence and improved diabetes outcomes.