The role of outcome expectancies and social support in adherence to nutrition counseling: perspectives of Emirati adults with diabetes

Objective: Diabetes represents a major public health burden in the Middle East and North Africa (MENA) region. However, limited research has explored patients' lived experiences and perspectives on diabetes management, particularly nutrition, within the Arab region. This study examined factors influencing adherence to dietitian-led counseling among adults with diabetes in the United Arab Emirates (UAE), with a focus on social support, outcome expectations, and patient suggestions to enhance motivation for dietary adherence. Methods: A qualitative study using semi-structured individual interviews was conducted with 44 adults with diabetes attending a diabetes management clinic in the UAE. Audio-recorded interviews were transcribed and analyzed using NVivo-12. Inductive thematic analysis guided by Social Cognitive Theory (SCT) was used to identify key concepts related to outcome expectations and social support. Participants' suggestions for improving motivation to seek nutrition advice from dietitians were also explored. Results: Four main themes emerged from the analysis: (1) positive expectations, (2) negative expectations, (3) enablers and motivators, and (4) participant suggestions. Positive outcome expectations, including improved health, better glycemic control, and weight management, motivated adherence to dietary advice. Social support from family members, friends, and healthcare professionals facilitated adherence and attendance at dietitian consultations. In contrast, misinformation, low awareness of the role of dietitians in diabetes management, and skepticism toward nutrition advice acted as barriers. Participants encouraged others with diabetes to consult dietitians and adopt healthier lifestyle behaviors. Conclusion: Enhancing culturally appropriate social support and addressing informational barriers may improve dietary adherence, increase engagement in dietitian-led counseling, and improve nutrition-related diabetes outcomes.