Co-design of pathway and manual for a dietitian-led approach to the management of type 2 diabetes in Nepal

Background: Type 2 diabetes (T2D) is a global public health problem, and its prevalence in resource-poor countries like Nepal has been rapidly increasing. However, there is a lack of a contextual and consistently structured, guided approach tailored to the integrated management of T2D in Nepal. Therefore, this study aims to co-design a pathway and manual for a dietitian-led dietary approach to the management of T2D in Nepal. Methods: The study used a co-design method guided by the “Design Thinking” approach. Data were collected through a purposively selected group of 14 participants who participated in a co-design workshop, and nine participants with whom qualitative interviews were conducted to validate the co-designed contents. Before conducting the co-design workshop, nineteen one-on-one consultative meetings were carried out with various stakeholders. The data analysis followed the content analysis technique and presented results under common broader themes. Results: The results from the first part of a co-design workshop are presented under themes including complexities of diabetes management in the Nepalese context, social and behavioural challenges, dietary adherence challenges and service providers’ responses, and treatment approaches. The results from the second part of the workshop are presented under the themes, including the pathway for the dietitian-led dietary approach for the management of diabetes and the contents and design of the Nutrition Education Manual for the management of T2D. Conclusions: The pathway co-designed for integrated management of T2D offers a contextual framework for understanding the mechanisms of change underlying the integrated efforts in T2D management. At the same time, the Nutrition Education Manual provides practical guidance for promoting healthy dietary behaviours among patients with T2D.