A Cross-sectional Study of Adherence to Lifestyle Modifications among Ambulatory Type 2 Diabetic Nigerians in a Resource-poor Setting of a Primary Care Clinic in Eastern Nigeria

Abstract

Background: Despite the evidence that lifestyle modifications (LSMs) play important role in glycaemic control, adherence to healthy lifestyles has been variable in Nigeria and this has great impact on the success or failure of pharmacological care. Aim: The study was designed to determine adherence to LSMs among ambulatory type 2 diabetic Nigerians in a resource-poor setting of a primary care clinic in Eastern Nigeria. Study Design: This was a primary care clinic-based cross-sectional study done on consecutively sampled 120 adult type 2 diabetic patients who were on management for diabetes mellitus for at least 3 months at the primary care clinic of a tertiary hospital in Nigeria. Place and Duration of Study: The study was carried out at the primary care clinic of a tertiary hospital in South-Eastern Nigeria from April 2011 to December 2011. Methodology: Instrument of data collection was pretested, structured and interviewer-administered questionnaire. Each item of lifestyle was scored on a five points Likert scale ordinal responses of always, most times, sometimes, rarely and none. Adherence to lifestyle modifications was assessed in the previous 12 months for alcohol and tobacco use and 7 days for physical activity, dietary fruits, vegetables, fats and oil consumptions. Each of the domains of lifestyle was given a score of one point for healthy lifestyle and zero point for unhealthy lifestyle. Type 2 diabetic patients who scored 6 points in all the evaluated domains were adherent. Awareness of LSMs and Specific adherence to lifestyle factors were also determined. Results: The awareness and overall adherence rates to LSMs were 88.3% and 22.5% respectively Specifically, adherence was highest with the non-tobacco use (100.0%) followed by adequate dietary vegetables consumptions (96.7%) and non-use of alcohol (90.8%). Other adherence rates were consumptions of adequate dietary fruits (51.7%), dietary fat and oils (23.3%) and physical activity (22.5%). Adherence was significantly associated with young age <40 years (p=0.039). Conclusion: The awareness of LSMs was high but was not translated to comparative adherence. The adherence to non-tobacco use was rated highest and physical activity the lowest. Young age <40 years was significantly associated with adherence. Targeting the domains of inadequate adherence for improvement is a primary care imperative especially in resource-poor settings where there are limited options for healthy living.