Abstract
Non-alcoholic fatty liver disease (NAFLD) is fast becoming a global public health concern as the obesity and diabetes epidemics continue to expand. Because there are currently no FDA-approved medications for NAFLD, the cornerstone of care is lifestyle modification counseling that leads to weight loss and increased frequency of physical exercise. Although controlled studies have shown that diet and exercise therapies can significantly improve NAFLD management, the scope and content of a clinic-based intervention suitable for routine clinical practice have yet to be identified. This study aims to inform clinical interventions for NAFLD patients by 1) identifying their perceived barriers to a healthy diet that may be influenced by lifestyle choices and/or behaviors, 2) assessing their health literacy and physical activity levels, 3) assessing differences in barriers to healthy eating by various health and behavior indicators (e.g., weight status, number of comorbidities), and 4) exploring patient and provider perceptions of what should be included in clinic-based lifestyle programs. An explanatory sequential mixed methods approach was utilized to guide this study. A quantitative phase collected data on patient’s perceived barriers to healthy eating, level of health literacy, and physical activity, and these findings were then explored further among participants and health providers during a qualitative phase analysis. The strongest perceived barriers to a healthy diet were a lack of self-control and a lack of understanding on how to adopt healthy behaviors. Based on inputs from patients and healthcare providers, this study identified perceived limitations, facilitators, and components of clinic-based interventions. Our findings highlight the importance of patient behavioral modifications, as well as improvements in attitudes and comprehension, which will assist in the management of these behaviors. To increase perceived barriers to healthy lifestyles, future clinical interventions for this group should integrate targeted education and behavioral approaches.