OBJECTIVES: Adherence to a healthy diet can decrease the risk of cardiovascular complications in people with type 2 diabetes, but non-adherence is a major problem in disease management. This study aims to investigate the underlying motives for food choices among people with type 2 diabetes. METHODS: People with type 2 diabetes were interviewed using Q methodology. Participants were asked to rank 41 statements on factors influencing food choices and to explain their ranking. By-person factor analysis was used to reveal factors, which were interpreted and described as viewpoints on what influences food choices using quantitative and qualitative data. RESULTS: Thirty purposely sampled people with type 2 diabetes in the Netherlands were included. This study revealed four viewpoints on underlying motives for food choices: "health and convenience", "health and concern", "enjoyment and healthy eating", and "enjoyment and convenience". Respondents representing the viewpoint labeled "health and convenience" cared most about healthy and easily prepared food. Those representing the viewpoint "health and concern" valued health highest and felt restricted by their health condition, but most of all groups permitted themselves to occasional guilty pleasures. People with the viewpoint "enjoyment and healthy eating" liked to eat healthy food and are willing to roll up their sleeves to see that happen. Finally, those with the viewpoint "enjoyment and convenience" also enjoyed eating, but although they were concerned about their health, convenience seemed to prevail over other factors. CONCLUSIONS: Albeit for different reasons, people with type 2 diabetes mostly seem to have an intrinsic motivation to eat healthily. However, those with the "enjoyment and convenience" motivation seem less willing to change their lifestyle in favor of their own health.