Submission ID 132015
| Issue/Objective | Although nutrition counselling is essential in diabetes management, its delivery in routine clinical practice remains largely unstandardized, inconsistent and rarely measured. Existing global guidelines outline the recommended components of such counselling, yet there is little evidence on how delivery meets the required standards and adheres to the guidelines in clinical practice. Patients receive both inadequate and or conflicting dietary and lifestyle advice across providers, leading to confusion and diminished clinical outcomes. This study addresses these critical gaps in delivery and measurement of counselling by systematically assessing the current counselling practices and proposing a structured approach to its delivery and measurement. |
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| Methodology/Approach | A cross-sectional study was conducted in 10 selected health facilities in Nakuru County, Kenya (January-February 2026). A total of 100 participants (health providers and patients) were included. Data were collected using non-leading provider questionnaires, patient surveys, and structured observation checklists. Counselling performance was evaluated using a novel weighted composite index capturing coverage of key domains, depth of content, consistency of health message, and adherence to global guidelines. Descriptive statistics and logistic regression were applied, with results reported as proportions, odds ratios (OR), and 95% confidence intervals (CI). |
| Results | Counselling was predominantly delivered by nutritionists (58%), yet remained largely incomplete (64%; 95% CI: 54.2-73.1), with only 52% of expected indicators addressed per session. Inconsistency was substantial, with 44% of sessions containing contradictory messages and 94% (95% CI: 83.5-98.7) of patients reporting conflicting advice. No facility had a standardized counselling guide. Absence of structured tools was significantly associated with incomplete counselling (OR=3.8; 95% CI: 1.6-8.9; p=0.003). The overall index score was 58%, indicating a fragmented counselling system. |
| Discussion/Conclusion | Significant gaps exist in the delivery of nutrition and lifestyle counselling in diabetes care, driven by a lack of standardized tools guiding its delivery and measurement in routine clinical setting. Development of standard tool to guide delivery of counselling, and a measurement tool for evaluating its depth, breath and consistency, as a measure of quality, are urgently needed to improve health outcomes. Continuous medical education of all health services providers on diabetes counselling is required. |
| Presenters and Affiliations | Daniel Matoke Ayienda kenya Medical Training College (KMTC); Kenya Medical Research Institute (KEMRI) Phoebe Wairimu Mwaura kenya Medical Training College (KMTC) Emily Nabifwo Wasike kenya Medical Training College (KMTC) |
