# Development of a culturally tailored medical nutrition therapy to improve dietary adherence in type 2 diabetes in Benin: an ORBIT model-based protocol

## TL;DR

This paper outlines a culturally tailored nutrition therapy program for type 2 diabetes in Benin, designed to improve dietary adherence and glycemic control.

## Contribution

The study introduces a culturally adapted MNT intervention using the ORBIT model in a low-resource African context.

## Key findings

- A hybrid framework integrating the ORBIT model and cultural adaptation approaches was developed.
- Mixed-methods data from 512 adults with T2D informed intervention refinement for feasibility and cultural relevance.
- The OSanDiaBé protocol aims to improve dietary adherence and glycemic control through culturally tailored MNT.

## Abstract

Dietitian-led medical nutrition therapy (MNT) is an effective and cost-efficient strategy for improving dietary adherence and glycemic control in adults with type 2 diabetes (T2D). However, culturally adapted MNT interventions that account for local food systems, food security, and sociocultural eating practices remain scarce in African contexts. This paper describes the development of Objectif Santé Diabète Bénin (OSanDiaBé), a culturally tailored, dietitian-led MNT intervention designed to improve dietary adherence and glycemic control among adults with T2D in Benin, West Africa, using the Obesity-Related Behavioral Intervention Trials (ORBIT) model.

To design OSanDiaBé, we use a hybrid framework integrating the ORBIT model with ecological validity and cultural adaptation approaches. In Phase Ia (Define), we developed a theory-driven model to identify key behavioral targets and hypothesized pathways linking a culturally tailored MNT intervention to dietary adherence and glycemic control. Phase Ib (Refine) involved adapting and refining an MNT intervention that combines evidence-based menu plans grounded in the 4A food security framework with individual nutrition counseling and group diabetes education. Intervention refinement was informed by mixed-methods data collected from 512 adults with T2D, including quantitative assessments, focus group discussions, sensory evaluations, and a stakeholder workshop, to enhance feasibility, acceptability, and cultural relevance.

Phase II will evaluate feasibility, acceptability, and preliminary signals of effectiveness, including dietary adherence and glycemic control (HbA1c), prior to planned Phase III efficacy and Phase IV effectiveness trials.

OSanDiaBé offers a replicable framework for culturally tailoring MNT interventions in low-resource settings. By integrating food security, culturally relevant dietary guidance, and family-centered nutrition support, this approach has the potential to strengthen diabetes nutrition care and reduce inequities in access to effective MNT across African contexts.