Evaluating Nutritional Policy Interventions for Managing Diabetes and Hypertension across Selected Health Facilities in Region Three, Guyana: A Mixed-Methods Study
Abstract:
The translation of nutritional policies into routine healthcare and sustainable dietary practices is crucial for the effective management of diabetes and hypertension. The Social Ecological Model (SEM) was employed in this study to evaluate the effect of nutritional policy interventions in some health facilities in Region Three, Guyana. A mixed-methods study was conducted at four public health facilities: the Goed Intent Health Centre (GIHC), the Parfaite Harmonie Health Centre (PHHC), Leonora Cottage Hospital (LCH) and the West Demerara Regional Hospital (WDRH). Quantitative data included 2,745 patients’ records, 17 healthcare providers and facility assessments, complemented by qualitative evidence on patient and community experiences. Inferential and descriptive statistics, which included multivariable logistic regression, were integrated with thematic findings across SEM levels. The overall facility implementation was 40.0%; however, provider knowledge ranged from 45.0% to 60.0%, and reported practice ranged from 33.8% to 50.0%. Awareness of Food-Based Dietary Guidelines ranged from 51.7% to 75.6%, compared with 16.9%–48.2% for the Dietary Approaches to Stop Hypertension (DASH). Greater nutritional awareness was independently associated with high reported dietary practice (OR = 1.11, 95% CI: 1.10–1.12; p < 0.001). Cost and affordability constituted the predominant patient-level barrier (63.5%), followed by cultural and food norms (19.7%). Qualitative findings reinforced the influence of economic constraints, household food practices, provider capacity limitations and weaknesses in routine implementation. Nutritional policy implementation for diabetes and hypertension in Region Three is shaped by the interplay of patient, provider, organizational, community and policy influences. Strengthening implementation requires coordinated multilevel action that combines provider and facility support with affordable, culturally appropriate, and practical dietary guidance.References:
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