Effect of Chinese health beliefs on compliance to dietetic advice in Hong Kong Chinese

Abstract

Social Cognitive Theory (SCT) was adopted as the theoretical framework to examine the impact of Chinese Health Beliefs (CHB), culture and lifestyle issues unique to Hong Kong on compliance with dietetic advice for weight management. Employing a mixed methods approach questionnaires and in depth interviews were used to obtain the views and perspectives of patients and dietitians. Consistent with SCT, individual and socio-cultural environmental factors were identified as barriers to compliance. Patients’ own CHB did not impact on compliance with dietitians’ advice, but CHB of family members and other socio-cultural factors in their environment acted as barriers. Patients accepted that CHB philosophies may differ to the dietitians approach but did not view this as a major problem as dietitians were able to accommodate their beliefs into dietetic advice. While acknowledging that most Chinese patients held dietary CHB, dietitians were concerned that there was potential conflict between these beliefs and dietetic advice which may impact on patient compliance. The lack of scientific evidence to support the safety and efficacy of dietary CHB was a concern and dietitians were hesitant to acknowledge formally the use or acceptance of CHB within their scope of practice. Dietitians and patients were in agreement regarding the socio-cultural barriers to complying with dietetic advice. Problems identified included frequent eating out, long working hours which affected food choice and family or cultural issues such as respect for elders and the need to maintain harmony making food refusal and following of a structured eating plan difficult. The results suggest that dietitians should continue to concentrate efforts on developing strategies to help patients overcome socio-cultural barriers to dietary compliance. This thesis also provides evidence that while the CHB and western biomedical systems differ from each other, it is possible to integrate them into dietetic practice.