Situational obstacles to dietary adherence for adults with diabetes.

OBJECTIVE To develop a taxonomy of everyday situations that create obstacles for adherence to dietary management in patients with diabetes. SUBJECTS Twenty-six adults with diabetes (12 with insulin-dependent diabetes mellitus and 14 with non-insulin-dependent diabetes mellitus) were recruited from an outpatient diabetes clinic. MAIN OUTCOME MEASURES Subjects were interviewed to identify problem situations that create obstacles for dietary adherence. The resulting 69 situations were judged for the presence or absence of 32 environmental features using a reliable coding system. STATISTICAL ANALYSIS A hierarchical cluster analysis was used to identify homogeneous groups of dietary adherence obstacles. RESULTS Twelve types of problem situations were identified: negative emotions, resisting temptation, eating out, feeling deprived, time pressure, tempted to relapse, planning, competing priorities, social events, family support, food refusal, and friends' support. CONCLUSIONS The resulting taxonomy provides an outline for the detailed assessment of obstacles to dietary adherence. An individual's ability to cope with this array of obstacles to dietary adherence should be assessed so treatment can be individualized.

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