SOCIAL SUPPORT AND ECONOMIC STATUS AS DETERMINANTS OF DIETARY ADHERENCE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS IN INDONESIA: A CROSS- SECTIONAL STUDY IN PRIMARY CARE

Adherence to dietary recommendations is an essential aspect of self-management in diabetes. A significant number of individuals with type 2 diabetes mellitus (T2DM) do not do a good job of maintaining adherence. Social and economic determinants, such as family support and financial resources, influence self-care actions, particularly in low- and middle-income countries. This study aimed to investigate the relationship between social environment or social determinants, as well as income determinants, and adherence to dietary recommendations among T2DM patients in Pontianak, West Kalimantan, Indonesia. Method: This cross-sectional, analytic correlational study was conducted between September and November 2024 at the Kitamura Clinic. A total of 172 respondents meeting the inclusion criteria were purposively sampled. Dietary adherence was measured using the modified Summary of Diabetes Self-Care Activities (SDSCA), and social environment was measured using the Social Support Questionnaire (SSQ). Economic level was based on the 2023 classification by the Central Bureau of Statistics (BPS). Data was analyzed using Spearman’s rho and multiple linear regression analysis, while adjusting for demographic covariates.  The study result showed that social support had a strong positive relationship with dietary adherence (rₛ = 0.612, p < 0.001). The economic level had a moderate and significant, though weaker, association with adherence (rₛ = 0.321, p < 0.001). In the multivariate model, both variables continued to be statistically significant predictors: social support (β = 0.367, p < 0.001) and economic level (β = 0.192, p = 0.002), explaining 35.6% of the variance in adherence (Adjusted R² = 0.356). Age, sex, and duration of diabetes were not statistically significant predictors of dietary adherence. Conclusion: The extent of adherence to dietary recommendations among T2DM patients is largely shaped by context, both social and economic. Community and family support for patients with T2DM, as well as economic empowerment efforts, can lead to improved self-management of the disease. Strategies aimed at integrating behavioral theories, such as the Health Belief Model and Social Cognitive Theory, into diabetes care should be urgently addressed to foster sustained adherence among patients with T2DM in Indonesia and similar settings with limited resources.