Perceptions and willingness to adopt whole-food, plant-based (WFPB) diets among rural adults with type 2 diabetes mellitus (T2DM) in low socioeconomic settings: a cross-sectional study

Abstract

India has often been referred to as the “diabetes capital” of the world because of its large burden of diabetes mellitus, while rural populations continue to face substantial barriers to timely and effective diabetes care. Among non-pharmacological interventions, a whole-food, plant-based (WFPB) diet has emerged as a cost-effective approach for improving glycemic control and metabolic health. However, its acceptability among socioeconomically disadvantaged rural populations remain poorly understood. Therefore, this study assesses the perceptions, willingness, and perceived barriers and facilitators to adopt a WFPB diet among rural adults with type 2 diabetes mellitus (T2DM). A hospital-based cross-sectional study was conducted between July and December 2025 among 120 adults with T2DM attending a tertiary care teaching hospital in rural Western Maharashtra, India. Participants were recruited using convenience sampling. Data on sociodemographic characteristics, clinical profile, dietary practices, perceptions, and willingness to adopt a whole-food, plant-based (WFPB) diet were collected using a self-structured interviewer-administered questionnaire. Associations between participant characteristics and motivational factors to adopt a WFPB diet were examined using Pearson’s Chi-square test or Fisher’s exact test, as appropriate. The mean age of participants was 57.2 ± 14.5 years, and the mean HbA1c level was 9.0 ± 3.6%, indicating generally poor glycemic control. More than half (55%) perceived a WFPB diet as highly beneficial for improving improve blood glucose levels; however, only 45% expressed willingness to adopt it. Willingness was significantly associated with educational status, household size, duration of diabetes, HbA1c level, and preferred mode of dietary support ( p  < 0.05). Participants with poor glycemic control and those with recently diagnosed with T2DM were more willing to adopt a WFPB diet, whereas, willingness declined with increasing disease duration. Although non-vegetarians showed greater willingness than vegetarians (85.2% vs. 3.4%), the association was not statistically significant. Willingness to adopt a WFPB diet among rural adults with T2DM is influenced by educational, household, and clinical factors rather than awareness alone. Family support, community engagement, and culturally appropriate nutrition counselling may play a key role in improving the long term adoption of WFPB diets and strengthening diabetes self-management in resource-constrained rural settings.