Designing an Innovative Medical Nutrition Therapy to Improve Dietary Adherence in Type 2 Diabetes Using the ORBIT Model: Protocol for Intervention Development in Benin, West Africa

Halimatou Alaofe^1*Abidemi Okechukwu¹Walou Amoussa Hounkpatin²Adaeze Oguegbu³Kelly Jackson⁴Edward Bedrick⁵John Ehiri¹

• ¹Department of health Promotion Sciences, University of Arizona, Tucson, United States
• ²Universite d'Abomey-Calavi Faculte des Sciences Agronomiques, Cotonou, Benin
• ³Division of Public Health Practice, Policy & Translational Research, University of Arizona, Tucson, United States
• ⁴Department of Nutritional Sciences and Wellness, University of Arizona, Tucson, United States
• ⁵Department of Epidemiology and Biostatistics, University of Arizona, Tucson, United States

Background. Dietitian-led medical nutrition therapy (MNT) is an effective and cost-efficient strategy for improving dietary adherence and glycemic control in adults with type 2 diabetes (T2D). However, culturally adapted MNT interventions that account for local food systems, food security, and sociocultural eating practices remain scarce in African contexts. This paper describes the development of Objectif Santé Diabète Bénin (OSanDiaBé), a culturally tailored, dietitian-led MNT intervention designed to improve dietary adherence and glycemic control among adults with T2D in Benin, West Africa, using the Obesity-Related Behavioral Intervention Trials (ORBIT) model. Methods. To design OSanDiaBé, we use a hybrid framework integrating the ORBIT model with ecological validity and cultural adaptation approaches. In Phase Ia (Define), we developed a theory-driven model to identify key behavioral targets and hypothesized pathways linking a culturally tailored MNT intervention to dietary adherence and glycemic control. Phase Ib (Refine) involved adapting and refining an MNT intervention that combines evidence-based menu plans grounded in the 4A food security framework with individual nutrition counseling and group diabetes education. Intervention refinement was informed by mixed-methods data collected from 512 adults with T2D, including quantitative assessments, focus group discussions, sensory evaluations, and a stakeholder workshop, to enhance feasibility, acceptability, and cultural relevance. Expected Outcomes. Phase II will evaluate feasibility, acceptability, and preliminary signals of effectiveness, including dietary adherence and glycemic control (HbA1c), prior to planned Phase III efficacy and Phase IV effectiveness trials. Conclusions. OSanDiaBé offers a replicable framework for culturally tailoring MNT interventions in low-resource settings. By integrating food security, culturally relevant dietary guidance, and family-centered nutrition support, this approach has the potential to strengthen diabetes nutrition care and reduce inequities in access to effective MNT across African contexts.