Exploring Dietitians’ Views on Healthy Dietary-Pattern Counselling for Adults with Type 2 Diabetes Mellitus in Tobruk, Libya: A Qualitative Study

Hamdi Lemamsha; Hanan Al Mahdi; Salma Mohammad; Kadija Hamd Saad; Manal Bou-Dhahab; Hafsa Bilqasem

doi:10.33214/dbtqd870

Authors

Hamdi Lemamsha Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author
Hanan Al Mahdi Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author
Salma Mohammad Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author
Kadija Hamd Saad Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author
Manal Bou-Dhahab Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author
Hafsa Bilqasem Faculty of Medical Sciences, University of Tobruk, Tobruk, Libya Author

DOI:

https://doi.org/10.33214/dbtqd870

Keywords:

Type 2 diabetes mellitus, Dietary counselling, Dietitians, Clinical nutritionists, Qualitative research, Libya

Abstract

Type 2 diabetes mellitus (T2DM) represents a growing public health challenge globally and in Libya, where increasing prevalence is associated with dietary behaviours, obesity, and lifestyle changes. Dietary-pattern counselling is a key component of diabetes management; however, limited evidence exists regarding how dietitians interpret and deliver such counselling within routine clinical practice in Libya. This study aimed to explore dietitians’ views and experiences of providing healthy dietary-pattern counselling for adults with T2DM in Tobruk, Libya. A qualitative descriptive design was adopted using semi-structured face-to-face interviews with 20 purposively selected dietitians and clinical nutritionists working in hospitals, primary healthcare centres, and private clinics. Interviews lasted approximately 30–45 minutes, were audio-recorded with participant consent, transcribed verbatim, and analysed using reflexive thematic analysis. Three major themes emerged from the analysis. The first, Translating Dietary Knowledge into Practical Counselling, highlighted the importance of individualising dietary advice and simplifying complex nutritional guidance to improve patient understanding and feasibility. The second, Contextual Barriers and Influences on Counselling, identified cultural food practices, family expectations, limited consultation time, and restricted resources as important influences on counselling delivery. The third, Patient Engagement and Response to Dietary Advice, revealed persistent misconceptions, health-literacy challenges, and difficulties maintaining long-term dietary adherence. Collectively, the findings suggest that effective dietary counselling depends on balancing evidence-based recommendations with cultural, socioeconomic, and behavioural realities. The study provides context-specific evidence that may inform the development of culturally appropriate educational resources, professional training initiatives, and structured dietary-counselling pathways to strengthen diabetes care within Libyan healthcare settings

REFERENCES

Ashawesh, M., Alkawash, M., Meigal, A., Almsiri, B., & Almasalati, A. (2025). Tracking the burden of type 2 diabetes mellitus among Libyan patients in three populated districts of Tripoli, Libya. Razi Medical Journal, 336–346.

Awuchi, C. G., Echeta, C. K., & Igwe, V. S. (2020). Diabetes and the nutrition and diets for its prevention and treatment: A systematic review and dietetic perspective. Health Sciences Research, 6(1), 5–19.

Boocock, R. C., Lake, A. A., Haste, A., & Moore, H. J. (2021). Clinicians’ perceived barriers and enablers to the dietary management of adults with type 2 diabetes in primary care: A systematic review. Journal of Human Nutrition and Dietetics, 34(6), 1042–1052. https://doi.org/10.1111/jhn.12875

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806

Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2023). Thematic analysis: A practical guide. SAGE Publications.

Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652–661. https://doi.org/10.1177/1744987120927206

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE Publications.

Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H. K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., Saslow, L., Uelmen, S., Urbanski, P. B., & Yancy, W. S., Jr. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care, 42(5), 731–754. https://doi.org/10.2337/dci19-0014

Forouhi, N. G. (2023). Embracing complexity: Making sense of diet, nutrition, obesity and type 2 diabetes. Diabetologia, 66(5), 786–799. https://doi.org/10.1007/s00125-023-05873-z

Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523. https://doi.org/10.1016/j.socscimed.2021.114523

Hushie, M. (2019). Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: A qualitative study in Ghana. Health Promotion Perspectives, 9(3), 223–232. https://doi.org/10.15171/hpp.2019.31

International Diabetes Federation. (2024). IDF diabetes atlas: Libya country profile. https://diabetesatlas.org

Kallio, H., Pietilä, A.-M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi.org/10.1111/jan.13031

Lemamsha, H., Randhawa, G., & Papadopoulos, C. (2019). Prevalence of overweight and obesity among Libyan men and women. BioMed Research International, 2019, 8531360. https://doi.org/10.1155/2019/8531360

Maxwell, J. A., & Reybold, L. E. (2015). Qualitative research. In J. D. Wright (Ed.), International encyclopedia of the social & behavioral sciences (2nd ed., Vol. 19, pp. 685–689). Elsevier.

Minari, T. P., Tácito, L. H. B., Yugar, L. B. T., Ferreira-Melo, S. E., Manzano, C. F., Pires, A. C., Vilela-Martin, J. F., & Yugar-Toledo, J. C. (2023). Nutritional strategies for the management of type 2 diabetes mellitus: A narrative review. Nutrients, 15(24), 5096. https://doi.org/10.3390/nu15245096

Moutou, K. E., England, C. Y., Gutteridge, C., Toumpakari, Z., McArdle, P. D., & Papadaki, A. (2022). Exploring dietitians’ practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study. Journal of Human Nutrition and Dietetics, 35(1), 179–190. https://doi.org/10.1111/jhn.12939

Petroni, M. L., Brodosi, L., Marchignoli, F., Sasdelli, A. S., Caraceni, P., Marchesini, G., & Ravaioli, F. (2021). Nutrition in patients with type 2 diabetes: Present knowledge and remaining challenges. Nutrients, 13(8), 2748. https://doi.org/10.3390/nu13082748

Ranasinghe, P., Pigera, A. S. A. D., Ishara, M. H., Jayasekara, L. M. D. T., Jayawardena, R., & Katulanda, P. (2015). Knowledge and perceptions about diet and physical activity among Sri Lankan adults with diabetes mellitus: A qualitative study. BMC Public Health, 15, 1160. https://doi.org/10.1186/s12889-015-2518-3

Shannon-Baker, P. (2016). Making paradigms meaningful in mixed methods research. Journal of Mixed Methods Research, 10(4), 319–334. https://doi.org/10.1177/1558689815575861

Siopis, G., Colagiuri, S., & Allman-Farinelli, M. (2020). Dietitians’ experiences and perspectives regarding access to and delivery of dietetic services for people with type 2 diabetes mellitus. Heliyon, 6(2), e03344. https://doi.org/10.1016/j.heliyon.2020.e03344

Staller, K. M. (2021). Big enough? Sampling in qualitative inquiry. Qualitative Social Work, 20(4), 897–904. https://doi.org/10.1177/14733250211024516

Wang, Y., Yuan, X., Gu, X., Meng, C., & Zheng, Y. (2023). Developing a conceptual model for understanding nutritional problems and their negative impacts on quality of life among Chinese patients with type 2 diabetes: A qualitative study. Nursing Open, 10(8), 5271–5281. https://doi.org/10.1002/nop2.1765

World Health Organization. (2023). Diabetes fact sheet. https://www.who.int/news-room/fact-sheets/detail/diabetes