Development of Culturally Congruent Regional Food Recipes for Type 2 Diabetes Management: A Mixed-Methods Study in Phitsanulok, Thailand

Abstract

Background: Dietary non-adherence remains a global barrier to effective Type 2 Diabetes Mellitus (T2DM) management, often exacerbated by a "one-size-fits-all" nutritional approach. In Thailand, despite the implementation of the "Clinical Practice Guideline for Diabetes 2023" and the "Phuwadol Model" for diabetes remission, many patients struggle to sustain behavioral changes due to cultural disconnects. Objectives: To develop and assess the sensory acceptability of culturally congruent regional food recipes for T2DM patients in Phitsanulok, Thailand. Methods: A convergent parallel mixed-methods design was utilized. Qualitative data explored dietary behaviors via in-depth interviews (n=30; comprising 10 patients, 10 caregivers, and 10 healthcare providers). Quantitative assessment involved a satisfaction survey (n=30) of two developed regional recipes. Results: Six qualitative themes emerged: (1) Pre-diagnosis "Sugar Attachment," (2) Post-diagnosis fear-driven adaptation, (3) The nurse’s role in communal support, (4) Misconceptions in regional nutrition, (5) Demand for evidence-based local recipes, and (6) Accessibility of local raw materials. The developed recipes (Banana Blossom Salad and Sour Curry with Lotus Stem) utilized local, low-glycemic index (GI) ingredients. Quantitative results showed exceptionally high satisfaction in visual appearance and taste. Conclusions: Integrating local culinary wisdom into nursing practice through Leininger’s framework may enhance dietary adherence. This model bridges the "knowledge-to-action" gap by aligning clinical standards with the lived cultural experience of the patient. However, these findings are limited to sensory acceptability and lack empirical glycemic or biochemical validation.