Psychological factors of healthful diet promotion among diabetics: an application of health action process approach.

Background and aim: Worldwide, type 2 diabetes mellitus (T2DM) prevalence has increased. Non-healthful diet is one of the main reasons to T2DM growth. This study aims to determine the efficacy of the health action process approach (HAPA) in explaining healthful diet (HD) in T2DM patients.

Methods: This cross-sectional study was conducted based on HAPA in Isfahan, Iran between July and December 2015. Participants were recruited by convenience sampling method. HAPA inventory was administered to 203 Isfahan diabetics. Intentions, outcome expectancies, risk perception, action self-efficacy, action and coping planning, maintenance and recovery self-efficacy, and dietary style were the constructs measured. Structural equation modeling (SEM) in AMOS 21 was used to test the hypothesis.

Results: The results based on the common fit indices revealed that the HAPA fitted the data acceptably well among the T2DM patients and within dietary behavior (p<0.001), RMSEA=0.082, CFI=0.903, NFI=0.899). Action self-efficacy was the best predictor of intention (β=2.49, p<0.001). Result revealed action and coping planning (β=5.36, p=0.027) and recovery self-efficacy (β=5.67, p=0.021) significantly predicted behavior.

Conclusions: Our findings provide preliminary support for the practical usage of the HAPA model for predicting HD intention and behavior among T2DM patients. Randomized controlled trials should be performed in the future in order to involve causality.