The Effect of Nutritional Education Program Based on Health Belief Model (HBM) on the Knowledge of Fasting Type 2 Diabetic Patients

Background and Objectives: Studies have shown that many people with diabetes are fasting in the holy month of Ramadan. Ramadan fasting causes several changes in metabolism, habit and lifestyle that are associated with an increased risk of hypoglycemia and hyperglycemia in diabetic patients. An educational program based on behavioral science theory in the field of diet and medication changes, proper physical activity during Ramadan fasting, recognizing risks and symptoms of fasting complications and the management may improve the diabetic patients' ability in changing lifestyle, reduce the risk of fasting complications and weight and metabolic control during Ramadan. This study aimed to investigate the effect of nutritional education program based on health belief model (HBM), on the knowledge of type 2 diabetic patients who fast in Ramadan. Materials and Methods: This randomized clinical trial was conducted on 53 type 2 diabetic patients referring to the Diabetes Clinic of Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences and tending to fast during Ramadan, who were recruited based on the research inclusion criteria. The subjects were randomly assigned into two groups of intervention (n=28) and control (n=25). A week before Ramadan, the intervention group was educated based on HBM. In a week before and after Ramadan, the data on demography, HBM components and knowledge were collected through face-toface interview by trained nutritionists. Results: The research results revealed that the education program in the intervention group significantly increased the HBM components such as perceived severity, perceived benefits, perceived barriers, and self-efficacy comparing to the baseline and the control group (P<0.005). At the end of the study, there was a significant difference in the scores of knowledge about fasting conditions and medications, nutrition and physical activity between the two groups (P<0.001, P=0.049 and P=0.013, respectively). The educational intervention significantly increased the total knowledge score, as well as the fasting conditions and medications and blood glucose control scores compared to the baseline values; also in comparison with the control group, the scores of fasting conditions and medications, blood glucose control and total knowledge increased significantly in the intervention group. Conclusions: The findings showed an increase the knowledge level and improvement in the HBM components in the intervention group compared with the control group. It seems that focused Ramadan education could increase Ramadan knowledge of patients and empower them to proper management of diabetes during the holy Ramadan.