Dietary Behaviors and Psychosocial Factors of People Managing Diabetes During Fasting: A Qualitative Study from Five US Muslim Communities

Objectives: This study sought to understand dietary behaviors among US Muslim people with Type 2 diabetes while managing diabetes and fasting during Ramadan, identify key psychosocial factors influencing behaviors, and examine how identified factors influence diet behaviors and health outcomes from the patient’s perspective. Methods: The study employed community-engaged research principles and qualitative research design. Twenty-two adult Muslim adults living with Type 2 diabetes for over 6 months participated in semi-structured one-on-one interviews. Participants were recruited from five US communities using purposive sampling. Three trained researchers used abductive coding, combining deductive and inductive approaches, to analyze the data. Results: Six main themes emerged from the data: (1) changes in dietary habits during Ramadan; (2) strong influence of religious, cultural and social practices on dietary behaviors; (3) variable self-efficacy in managing dietary behaviors; (4) impact of prior habits and current blood glucose status; (5) decision-making based on diabetes-related health outcomes (e.g., experiencing low blood sugar); (6) participants’ perception of Ramadan as an opportunity for sustainable behavioral changes. Conclusions: This study is among the first to document the dietary behaviors and key psychosocial factors influencing dietary behaviors and health outcomes for US Muslim people with Type 2 diabetes during Ramadan. The study suggests that interventions to improve diabetes control and promote diabetes remission among Muslims can benefit from cultural tailoring that draws on Ramadan religious, cultural and social practices to encourage sustainable behavioral change.