Evaluating Barriers to Adherence to Dietary Recommendations in Iranian Adults with Metabolic Syndrome: A Qualitative Study Using the Theory of Reasoned Action
Abstract
Background: Metabolic syndrome (MS) is defined as a pattern of metabolic disorders including central obesity, insulin resistance or hyperglycemia, high blood pressure, and dyslipidemia. Many studies show a clear relationship between diet and components of MS. The aim of the current study was to identify barriers to adherence to dietary recommendations among Iranian MS patients.
Methods: The theory of reasoned action (TRA) served as the framework for this qualitative study. Data collection was conducted through six semi-structured focus group discussions, from Apr to Jun 2013. Subjects included 36 married men and women with different levels of education between the ages of 20-50 with MS diagnosed based on IDF’s (International Diabetes federation) criteria. All focus group discussions were audio recorded and transcribed. The thematic content analysis method was used to analyze the study data.
Results: This study identified the most important barriers to adherence to dietary recommendations. MS patients have problems in their attitude toward MS components and their relationship to nutrition. They also had wrong attitudes toward fats and oils, salt, dairy products, cereals, and sugary drinks and sweets. Subjective norms that affects patient eating identifies too.
Conclusion: We identified barriers to adherence to dietary recommendations in MS patients that could be used to prevent MS consequences and provide patients with nutrition education.
Baxter A, Coyne T, McClintock C (2006). Dietary patterns and metabolic syndrome - a review of epidemiologic evidence. Asia Pac J Clin Nutr, 15(2):134-4.
Grundy SM (2008). Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol, 28(4):629-36.
Sedehi M, Mehrabi Y, Khodabakhshi A (2011). Using principal component analysis to increase accuracy of prediction of metabolic syndrome in artificial neural network and logistic regression model. J Shahrekord Univ Med Sci, 13(4): 18-27.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. (2005). Diagnosis and management of the metabolic syndrome. An American heart association/national heart, lung, and blood institute scientific statement. Circulation, 112(17):e297.
Lutsey P, Steffen L, Stevens J (2008). Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation, 117(6): 754-61.
Pan Y, Pratt CA (2008). Metabolic syndrome and its association with diet and physical activity in US adolescents. J Am Diet Assoc, 108(2): 276-86.
Dalle Grave R, Calugi S, Centis E, Marzocchi R, El Ghoch M, Marchesini G (2010). Lifestyle modification in the management of the metabolic syndrome: achievements and challenges. Diabetes Metab Syndr Obes, 3:373-85.
Hearty AP, McCarthy SN, Kearney JM, Gibney MJ (2007). Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adults. Appetite, 48(1):1-11.
Redding CA, Rossi JS, Rossi SR, Velicer WF, Prochaska JO (2000). Health behavior models. Int Electron J Health Educ, 3: 180-193.
Ajzen I, Fishbein M (1977). Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychol Bull, 84(5), 888-918.
Didarloo AR, Shojaeizadeh D, Gharaaghaji Asl R, Habibzadeh H, Niknami Sh, Pourali R (2012). Prediction of self-management behavior among Iranian women with type 2 diabetes: application of the theory of reasoned action along with self-efficacy. Iran Red Crescent Med J, 14(2):86-95.
Khanna R, Kavookjian J, Scott VG, Kamal KM, Miller LA, Neal WA (2009). Using the theory of reasoned action to determine physicians’ intention to measure body mass index in children and adolescents. Res Social Adm Pharm, 5(2):170-81.
Messina F, Saba A, Vollono C, Leclercq C, Piccinelli R (2004). Beliefs and attitudes towards the consumption of sugar-free products in a sample of Italian adolescents. Eur J Clin Nutr, 58(3):420-8.
Bartee RT, Grandjean BD, Dunn M, Eddy j, Wang MQ (2004). Predictors of dietary supplement use among adolescent athletes. Pediatr Exerc Sci, 16(3): 250-64.
Brewer JL, Blake AJ, Rankin SA, Douglass LW (1999). Theory of reasoned action predicts milk consumption in women. J Am Diet Assoc, 99(1):39-44.
Didarloo A, Shojaeizadeh D, Eftekhar Ardebelli H, Niknami S, Hajizadeh E, Alizadeh M (2011). Assesment of factors affecting self-care behavior among women with type 2 diabetes in Khoy city diabetes clinic using the extended theory of reasoned action. J Sch Public Health Inst Public Health Res, 9(2): 79-92.
Mazloomi mahmoodabad S, Motlagh Z, Morowati Sharifabad MA, mozaffarikhosravi H, Askarshahi M (2011). The efficasy of reasoned action theory in determining factors related to salt consumption among women referring to Yazd health care centers. Health System Res, 7(4): 504-514.
Alberti KG, Zimmet P, Shaw J (2006). Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med, 23(5):469-80.
Ford ES, Giles WH, Mokdad AH (2004). Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes Care, 27(10):2444-9.
Pi-Sunyer FX (2006). Use of lifestyle changes treatment plans and drug therapy in controlling cardiovascular and metabolic risk factors. Obesity, 14 Suppl 3:135S-142S.
Cutler GJ, Flood A, Hannan P, Neumark-Sztainer D (2011). Multiple sociodemographic and socioenvironmental characteristics are correlated with major patterns of dietary intake in adolescents. J Am Diet Assoc, 111(2):230-40.
Dorsey RR, Eberhardt MS, Ogden CL (2009). Racial/Ethnic differences in weight perception. Obesity, 17(4):790-5.
Mama SK, Quill BE, Fernandez-Esquer ME, Reese-Smith JY, Banda JA, Lee RE (2011). Body image and physical activity among latina and african american women. Ethn Dis, 21(3):281-7.
Hansson LM, Rasmussen F (2014). Attitudes towards obesity in the Swedish general population – The role of one’s own body size, weight satisfaction, and controllability beliefs about obesity. Body Image, 11(1):43-50.
Grimes CA, Riddell LJ, Nowson CA (2009). Consumer knowledge and attitudes to salt intake and labelled salt information. Appetite, 53(2):189-94.
Naghibi SA, Yahyazadeh R, Yazdani Cherati J (2012). Knowledge, attitude referred to health centers on salt intake. J Mazandaran Univ Med Sci, 22(95): 99-104.
Jafari F, Kholdi N, Davati A, Nezamdust Z (2013). The study of oils consumption pattern and its related factors in east Tehran. J Fasa Univ Med Sci, 3(3): 202-7.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. (2012). A comparative risk assessment of burden of disease and injury at¬tributable to 67 risk factors and risk factor clus¬ters in 21 re¬gions, 1990–2010: a systematic analy¬sis for the Global Burden of Disease Study 2010. Lancet, 380(9859):2224-60.
Shepherd R, Farleigh CA (1986). Attitudes and personality related to salt intake. Appetite, 7(4):343-54.
Safaryan M, Shojaei zadeh M, Ghayour mobarhan M, Esmaeili H, Nemati M, razavi A (2013). Investigation of dietary patterns, healthy eating index and traditional risk factors of cardiovascular disease in 35-65 years old adults of mashhad. Med J Mashhad Univ Med Sci, 56(4): 226-35.
Falahi E, anbari K (2013). Identification of dietary patterns among Iranian adults. Yafteh, 14(5): 29-39.
Esmaillzadeh A, Mirmiran P, Azizi F (2005). Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr, 59(3):353-62.
Sahyoun NR, Jacques PF, Zhang XL, Juan W, McKeown NM. (2006). Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults. Am J Clin Nutr, 83(1):124-31.
Ellis JM. A Whole grain intervention in older Americans nutrition program participants [Phd thesis]. The University of Georgia, Greece, 2001.
Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, et al. (2007). Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation, 116(5):480-8.
Yoo S, Nicklas T, Baranowski T, Zakeri IF, Yang SJ, Srinivasan SR, et al. (2004). Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: the Bogalusa heart study. Am J Clin Nutr, 80(4):841-8.
Rose G (2001). Sick individuals and sick pop¬ulations. Int J Epidemiol, 30(3):427-32.
Keshavarz Z, Simbar M, Ramezankhani A (2010). Effective factors on nutritional behavior of female workers based on "Integrated model of planned behavior and self-efficacy": A qualitative approach. Hakim Res J, 13(3): 199-209.
Soyer MT, Ergin I, Gursoy ST (2008). Effects of social determinants on food choice and skipping meals among Turkish adolescents. Asia Pac J Clin Nutr, 17(2):208-15.
Reger B, Wootan MG, Booth-Butterfield S (1999). Using mass media to promote healthy eating: A community-based demonstration project. Prev Med, 29(5):414-21.
Backman DR, Haddad EH, Lee JW, Johnston PK, Hodgkin GE (2002). Psychosocial predictors of healthful dietary behavior in adolescents. J Nutr Educ Behav, 34(4):184-92.
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| Issue | Vol 45 No 7 (2016) | |
| Section | Original Article(s) | |
| Keywords | ||
| Metabolic syndrome Theory of reasoned action Dietary recommendations Barriers | ||
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