Perceived barriers to healthy eating and self-efficacy among Indian adults at high risk of type 2 diabetes: a secondary analysis of the K-DPP study.

Introduction: Low fruit and vegetable (FV) consumption is a major contributor to the rising burden of non-communicable diseases, yet intake in India remains far below recommended levels. Although structural barriers to healthy eating are widely documented, little is known about how perceived barriers and dietary self-efficacy influence FV intake in high-risk populations, especially in a country like India. Methods: This study analyzed longitudinal data from 1,007 Indian adults participating in the Kerala Diabetes Prevention Program (K-DPP) in order to examine the effects of perceived barriers and dietary self-efficacy on FV intake over 9 years. Linear mixed-effects models were used to evaluate five perceived barrier domains and four dietary self-efficacy items in relation to FV intake (g/day) across four waves. Predictors were modeled categorically using the lowest-barrier and highest-efficacy groups as reference groups, with adjustment for demographic and behavioral covariates. Results: Higher perceived barriers related to availability (β = -53.9 g/day, 95% CI [-80.7, -27.3], Discussion: These findings highlight that perceived structural constraints, particularly limited availability and affordability, are key correlates of low FV intake in this population, and may inform interventions that prioritize improving access to FVs as a foundation for sustainable dietary improvement.