Diet self-management and education encounter in confucianism-dominated culture: a qualitative study of taiwanese with poor diabetes control

A diet self-management plan aligning with patients' culture, beliefs, and values is essential to the success of diabetes self-management education (DSME), which requires candid communication between patients and providers. However, in a Confucianism-dominated culture, the emphasis on social hierarchy, respect for authority, and harmony may hinder patients from communicating openly with healthcare teams. This qualitative study was conducted in accordance with the guidelines of the Consolidated Criteria for Reporting Qualitative Research to explore the experiences of participants with poor diabetes control, focusing on the challenges they face in diet self-management and how they communicate these challenges to their providers during DSME encounters. The present study revealed that the 'fear of being judged' reflects the Confucian culture, which inhibits open dialogue between patients and healthcare teams about the difficulties patients face in managing their diet. Given the high prevalence of poor diabetes control in Confucianism-dominated societies, it is strongly recommended to modify the approach of DSME, such as using patients' food diary as the base for the DSME discussion to avoid requiring patients to ask questions to the healthcare team, to fit the Confucian culture dominating in Eastern Asian societies.