INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a serious public health concern. Improving the quality of life and health outcomes of persons living with T2DM (PLwD) requires that they follow self-care practices such as dietary self-care (DSC). This study aimed to investigate the patterns, experiences, and outcomes of DSC among PLwD in Ghana. METHODS: Using a convergent parallel study design, the multicentre study was conducted in four hospitals in the Ashanti Region of Ghana. In the quantitative phase, 404 PLwD were conveniently sampled to complete surveys. All missing observations were dropped. Thus, the final analysis included 398 complete datasets. The analysis included descriptive analysis, chi-square tests, analysis of variance (ANOVA), independent t-tests, and multivariable logistic regression. Statistical significance was pegged at p<0.05. All analyses were completed in STATA 18. In the qualitative phase, semi-structured interviews were conducted among 43 purposively sampled participants including 12 PLwD, 12 family caregivers (FCGs), 7 healthcare professionals (HCPs), and 12 health policymakers (HPMs). The socio-ecological model (SEM) and health belief model (HBM) guided the study, and framework analysis was employed to generate codes that were categorised into sub-themes and themes deductively. RESULTS: Overall, only 9.5% of PLwD in this study had good DSC adherence. Good DSC adherence was predicted by having a family history of diabetes (AOR=2.85, 95% CI: 1.38-5.88), higher diabetes knowledge (AOR=1.16, 95% CI: 1.01-1.35), high perceived severity (AOR=6.79; 95% CI: 1.20-38.39), and being diagnosed symptomatically (AOR=2.64, 95% CI: 1.20-5.80). Conversely, having no formal education (AOR=0.55, 95% CI: 0.18-1.69) and owning a glucometer (AOR=0.43, 95% CI: 0.21-0.87) were associated with significantly lower odds of DSC adherence. Higher cues to action was associated with a higher likelihood of having a healthful eating plan [β=1.61, 95% CI: 0.38, 2.83] and following their eating plan [β=1.48, 95% CI: 0.25, 2.71]. PLwD who received full support from HCPs were more likely to have a healthful eating plan [β=2.36; 95% CI: 0.99, 3.73] and follow that plan [β=2.34, 95% CI: 1.08, 3.61]. On the other hand, those who received some support from their family had significantly lower adherence to following their eating plan compared to those with no family support [β= -1.15, 95% CI: -2.29, -0.02]. Also, higher diabetes knowledge was associated with a higher likelihood of consuming fruits and vegetables [β=0.31, 95% CI: 0.22, 0.40], high fat diet [β=0.06, 95% CI: 0.00, 0.13], and practising carbohydrate spacing [β=0.15, 95% CI: 0.05, 0.25]. An estimated 38.7% of PLwD had depression while 27.1% experienced diabetes distress. Good dietary adherence was associated with significantly lower odds of depressive symptoms (AOR=0.28; 95% CI: 0.10-0.78). However, the association between good DSC adherence and diabetes distress was not statistically significantly [β= -0.19, 95% CI: -0.42, 0.04, p=0.099].Four themes emerged on DSC experiences among PLwD: 1) timing of accessing dietary support from HCPs; 2) sources of knowledge on DSC; 3) controlling and limiting foods from external/outside sources; and 4) considerations for meal preparations. Four multi-level facilitators of DSC were also identified at the individual (i.e., patient’s knowledge of and attitudes towards DSC; and perceived benefits of adherence and seriousness of non-adherence to DSC), interpersonal (family support; and cues to action), institutional (advice from HCPs; attitudes and rapport of HCPs; and follow-ups from HCPs), and policy levels (i.e., collaboration with community volunteers and non-governmental organisations; and policy of having diabetes clinics in healthcare facilities). Barriers to DSC similarly operated across individual (i.e., patients’ resistance to lifestyle changes; patients’ financial constraints; previous bad experience with diabetes association/peer support group; and overreliance on non-professional dietary advice and misperception/misinformation), interpersonal (FCGs’ feelings of distress and giving up; and inadequate social support), institutional/community (lack of formal education on DSC among HCPs; insufficient equipment for anthropometric and physical measurements; low staff strength; and contextual limitations and high costs of healthy foods), and policy implementation levels (lack of funds for programmes). Stakeholder support for DSC involved HCPs delivering education, monitoring, and psychosocial care and preparing FCGs for caregiving role; FCGs providing practical, emotional, and financial support; and health authorities ensuring supervision, quality control, and capacity building of HCPs. CONCLUSION: The findings highlight the importance of improving diabetes and dietary education among PLwD and relevant stakeholders such as FCGs and HCPs as well as improving the supervisory and training capacity of HPMs towards achieving DSC adherence among PLwD. There is a need for pro-poor and pro-uneducated interventions targeted at PLwD, while improving access to healthy food environments (including availability and affordability) in Ghana. Additionally, there is a need to prioritise the mental health of PLwD in Ghana, making efforts to incorporate mental health screening into routine diabetes care services. Lastly, anthropometric measures should be routinely monitored among PLwD during clinical assessment while empowering PLwD to self-monitor at home. KEYWORDS: Barriers, dietary self-care, experiences, facilitators, outcomes, type 2 diabetes.