Feasibility and acceptability of a culturally adapted medical nutrition therapy intervention for adults with type 2 diabetes in Benin: a single-arm mixed-method study

Introduction Medical nutrition therapy (MNT) is a cornerstone of type 2 diabetes (T2D) management, but access to culturally appropriate nutrition care remains limited in many low-resource settings. We evaluated the feasibility and acceptability of OSanDiaBé, a culturally adapted MNT intervention for adults with T2D in Cotonou, Benin, West Africa. Methods Guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) framework, we conducted an ORBIT Phase IIa single-arm, pre-post mixed-methods feasibility study among adults aged 40–65 years with T2D. The intervention combined two individualized nutrition counseling sessions with eight group sessions delivered by trained dietitians and nutritionists in community settings over 12 weeks. Primary outcomes were recruitment, retention, attendance, intervention fidelity, and acceptability. Secondary exploratory outcomes included diabetes knowledge, diet quality, physical activity, diabetes self-efficacy, anthropometry, blood pressure, and glycated hemoglobin (HbA1c). Quantitative data were analyzed descriptively and using paired comparisons, while qualitative data were analyzed using reflexive thematic analysis. Results Among 42 adults screened, 36 were enrolled (85.7%), and 30 completed the 12-week follow-up (83.3% retention). Mean attendance was 7.2 of 8 group sessions, and intervention fidelity exceeded 85%. The prespecified acceptability progression criterion was met, with a mean overall satisfaction rating of 4.87 ± 0.35, exceeding the prespecified threshold of ≥4.0. Exploratory improvements were observed in overall diabetes knowledge (50.0–83.3%), diet quality (+9.29 points), regular physical activity participation (26.7–86.7%), and diabetes self-efficacy (+15.45 points). Mean HbA1c decreased by 0.58 percentage points (95% CI −1.12 to −0.04), with modest reductions also observed in body weight and body mass index. Qualitative findings identified culturally tailored educational materials, practical tools, peer support, and community-based delivery as important factors supporting participant engagement and intervention acceptability. Discussion OSanDiaBé was feasible to implement and highly acceptable among adults with T2D in urban Benin. These findings support progression to a pilot randomized controlled trial to further evaluate the intervention and generate preliminary estimates to inform subsequent effectiveness, implementation, economic, and scalability research.