Vol 10, No 3 (2021)
Research paper
Published online: 2021-03-03

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Pre-diabetic women’s understanding of the role of diet in preventing diabetes using the PEN-3 cultural model

Mostafa Alimehr1, Samira Malayen2, Zahra Karimipour3, Kobra Doostifar4, Fereshteh Sohrabi Vafa5, Maryam Nikbina6
Clin Diabetol 2021;10(3):261-269.


Background. Pre-diabetes is one of the most widespread
epidemics in the world. Pre-diabetics are the
most susceptible to diabetes. The prevalence of prediabetes
status is higher than that of diabetes. Lifestyle
modification at this stage may delay the onset of type
2 diabetes for ten years. The present study aims at determining
the Dezful pre-diabetic women’s experiences
of diabetic preventive eating behaviors.

Methods. The present study employed a directed qualitative
content analysis (DQlCA) conducted in Dezful in
2020. The experiences of 41 pre-diabetic women aged
30–65 years and 9 health care providers (physicians,
nutritionists, public health experts) were explained
using the in-depth interviewing technique on the factors
affecting diabetes preventive behaviors, including
nutritional behaviors and physical activities, based on
the constructions of the PEN-3 model. The participants
were selected from Dezful health centers. Analysis of
the qualitative data was done via a directed qualitative
content analysis (DQlCA). Data validity was estimated
by assessing acceptability, reliability, adaptability, and

Results. the most appropriate and accessible way to
promote diabetes prevention behaviors in pre-diabetics
is to hold training classes with a health promotion
approach implemented by health care providers.

Conclusion. Pre-diabetic women have a variety of beliefs
and habits influenced by awareness, food culture,
and temporal and spatial constraints. By identifying the
positive and negative beliefs affecting diet, researchers
who want to promote the nutritional behavior of
pre-diabetic women should correct and eliminate negative
and inhibitory beliefs by targeting these beliefs,
emphasizing positive and motivating beliefs. They also
should use the mentioned points in their educational

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