Abstract
Background and objective Carbohydrate quality, particularly glycemic index (GI), plays a critical role in the prevention of non-communicable diseases (NCDs). Despite growing awareness of low-GI diets, evidence on how knowledge and attitudes translate into dietary practices among urban working women in South Asia remains limited. This study assessed knowledge, attitudes, and dietary practices (KAP) related to low-GI foods among urban working women in Western Province, Sri Lanka, and examined associations between KAP domains and sociodemographic characteristics, as well as perceived barriers and facilitators influencing low-GI food consumption. Methods A validated, self-administered online questionnaire was used to collect data from 700 urban working women. The tool assessed sociodemographic characteristics and KAP related to low-GI foods and included open-ended questions to explore contextual barriers and facilitators. Knowledge, attitude, and practice scores were categorized as poor, average, or good. Associations were examined using chi-square tests, and qualitative responses were thematically analyzed. Results Among participants, 48.1% (337) correctly identified the concept of GI, while only 41.1% (288) recognized the correct low-GI range (<55). Brown rice was identified as a low-GI food by 62.1% (435), whereas only 12.4% (87) correctly recognized white rice as high-GI. Positive attitudes toward low-GI foods were high, with 87.4% (612) agreeing that incorporation promotes health and 86.1% (603) perceiving blood sugar control as important. Interest in learning about low-GI benefits was reported by 94.5% (662), and 81.5% (571) were willing to include low-GI foods in daily meals. Despite this, dietary practices were suboptimal: 45.9% (321) consumed low-GI foods once a week, 32.0% (224) rarely or never, and only 4.7% (33) daily; 58.0% (406) never checked GI values, and 49.4% (346) never read food labels. Associations were observed between knowledge and attitudes (χ² = 43.6, p < 0.05), knowledge and practices (χ² = 68.9, p < 0.05), and attitudes and practices (χ² = 4.0, p < 0.05), highlighting a persistent knowledge-practice gap. Age, education, and income were significantly associated with KAP domains (p < 0.05). Thematic analysis revealed key barriers, including time constraints (work/home responsibilities), limited availability and higher cost of low-GI foods, habitual dietary patterns, taste preferences, and frequent eating outside the home. Facilitators included health awareness, disease prevention motivation, and access to simple nutrition information, practical cooking skills, and availability of convenient low-GI snacks. Conclusions Despite adequate knowledge and positive attitudes, translation into low-GI dietary practices remains limited among urban working women. Interventions must move beyond awareness-building to address structural, behavioral, and environmental barriers to improve carbohydrate quality in urban diets.