Healthcare providers’ knowledge, attitudes, and practices in nutrition management for patients with type 2 diabetes mellitus in Kinshasa: a cross-sectional study in Democratic Republic of the Congo

BACKGROUND: Nutrition is critical for diabetes management, yet evidence about healthcare providers' knowledge, attitudes, and practices (KAP) in sub-Saharan Africa, including the Democratic Republic of the Congo (DRC), remains limited. We evaluated healthcare providers' KAP related to nutrition management for patients with type 2 diabetes in Kinshasa and explored links between knowledge, attitudes, and practice. METHODS: We conducted a descriptive correlational cross-sectional study between November and December 2024 among healthcare providers in diabetes care in Kinshasa, DRC. Using probabilistic multi-stage sampling of healthcare facilities across all 35 health zones, 877 healthcare providers were interviewed. KAP scales were scored across sociodemographic and professional characteristics and family history of diabetes. Structural equation modelling estimated direct and indirect effects among knowledge, attitude, and practice and evaluated determinants. RESULTS: Among 877 healthcare providers, there were 267 doctors, 574 nurses, and 36 nutritionists. The median age was 39 years (IQR = 32-46), and a minority had received diabetes-related training within the past 12 months (232/877; 26%). Mean scores for knowledge were 11.9/19 (SD = 2.6), for attitude 11.9/14 (SD = 2.9), and for practice 10.0/17 (SD = 5.4). While most healthcare providers (809/877; 89%) agreed that nutrition is fundamental for diabetes care, many healthcare providers viewed nutritional management for hospitalised patients as the nutritionist's sole responsibility. Many healthcare providers reported that they did not utilise any record form for nutritional assessment (499/877; 56.9%) or any record for nutrition-related issues or diagnoses (446/877; 50.9%). Structural equation modelling showed that both knowledge (β = 0.54, p < 0.001) and attitudes' scores (β = 0.81, p < 0.001) significantly influenced practices, with attitude mediating the effect of knowledge on practice. Professional category and training were the strongest predictors of higher KAP scores, whereas female sex was negatively associated with scores for both knowledge and attitude. CONCLUSION: The study revealed major gaps in healthcare providers' knowledge and practices on nutrition management in Kinshasa, shaped by both knowledge and attitudes. Differences by profession and sex highlight training inequities. Despite its cross-sectional and self-reported limitations, the study highlights the need for targeted, context-specific interventions to strengthen frontline healthcare providers' skills and attitudes on that aspect in urban sub-Saharan Africa.