Nutrition Counselling for Cardiometabolic Multimorbidity

Dietary Adherence

Perceived dietary adherence will be assessed using 11 items questionnaire adapted from the Perceived Dietary Adherence Questionnaire (PDAQ) and tailored to align with the core principles of the Dietary Approaches to Stop Hypertension (DASH) diet. It includes 11 items covering consumption of fruits, vegetables, whole grains, high-fiber foods, low-glycemic index carbohydrates, fish and other omega-3 rich foods, healthy oils, sugary foods and drinks, high-fat or fried foods, salt intake, and overall adherence to dietary recommendations. Participants will be categorized as good adherence if they achieve a total score of 44 or higher (following recommended dietary practices on four or more days per week for all 11 items) and poor adherence if they score less than 44 (fewer than four days per week).

Fasting Blood Glucose

To test fasting blood glucose(FBG), a 5 ml venous blood sample will be drawn in the morning after overnight fasting for at least 8 hours. Laboratory's venipuncture and specimen handling SOPs will be followed during sample collection. Blood samples will be collected using sterile tubes and handled using standard infection prevention and control procedures. FBG will be analyzed using biochemistry analyzers, following the manufacturer's SOP and laboratory quality assurance guidelines. Calibration and internal quality control procedures will be performed daily. The FBG test will be conducted under the supervision of senior medical laboratory technologists to ensure accuracy and adherence to SOPs. Higher values indicate poorer glycemic control.

Blood pressure

Blood pressure will be measured in accordance with the Ethiopian National NCD protocol. Participants will be seated comfortably with their back supported and legs uncrossed, and will remain relaxed for at least five minutes prior to measurement. They will be instructed to remain silent during and between measurements. Two blood pressure readings will be taken using a calibrated digital sphygmomanometer, with measurements spaced at five-minute intervals. The average of the systolic and diastolic readings will be used for analysis. Higher readings indicate poorer blood pressure control.

Nutrition-related Quality of Life

NQoL will be assessed using a structured questionnaire developed based on the original NQoL instrument by Barr and Schumacher (2003) and adapted for relevance to CMM patients. The tool will evaluate patients' perceptions of how their dietary habits and nutrition-related experiences affected various dimensions of their daily lives over the past two weeks. The questionnaire is organized into six domains: Food Impact, Self-Image, Psychological Factors, Social and Interpersonal Factors, Physical Functioning and Role, and Self-Efficacy. Participants will be responded to each item using a five-point Likert scale. The total possible score will be ranging from 21 to 105. Subscale scores will also have computed for domain-specific interpretation. Higher total and domain-specific scores will reflect more positive perceptions of the impact of nutrition on physical, psychological, social, and functional well-being.