A narrative systematic review of factors affecting diabetes prevention in primary care settings

Abstract

BackgroundType 2 diabetes is impacting millions of people globally; however, many future cases can be prevented through lifestyle changes and interventions. Primary care is an important setting for diabetes prevention, for at-risk populations, because it is a patient’s primary point of contact with the health care system and professionals can provide lifestyle counselling and support, as well as monitoring health outcomes. These are all essential elements for diabetes prevention for at-risk adults.AimTo understand the factors related to the delivery and uptake of type 2 diabetes prevention interventions within primary care in higher income countries.MethodsFor this narrative systematic review, we combined qualitative and quantitative studies of diabetes prevention within a primary care setting for patients at-risk of developing the condition. We used an iterative approach for evidence collection, which included using several databases (MEDLINE, Embase, Pysch info, BNI, SSCI, CINAHL, ASSIA), where we combined diabetes terms with primary care terms. Narrative and thematic synthesis were utilised to identify the prominent themes emerging from the data.ResultsA database of 6646 records was screened by the research team, and 18 papers were included. Three major themes were identified in this review. The first theme of context and setting of diabetes progression includes the risk and progression of diabetes, primary care as a setting, and where the responsibility for change is thought to lie. This review also found mixed views on the value of preventative services within primary care. The second theme focused on the various patient factors associated with diabetes prevention such as a patient’s motivation to modify their current lifestyle, perceptions and knowledge (or lack thereof) of the impacts of diabetes, lack of follow-up in healthcare settings, and trust in healthcare professionals. The third theme was centred on professional factors impacting on diabetes prevention which included workload, time constraints, resources, self-efficacy and knowledge as well as professionals’ perception of patient motivations towards change.ConclusionThis review explored the factors influencing diabetes prevention in primary care, and identified the context of prevention, as well as patient and professional factors related to preventative services being offered in primary care. This systematic review complements previous reviews of real-world settings by exploring the significant factors in prevention, and the findings are relevant to academics, policymakers, patients and practitioners interested in understanding the factors associated with the delivery and uptake of diabetes prevention interventions.

Barriers and Enablers to Make Lifestyle Changes among Type 2 Diabetes Patients: A Review

“…The data were recorded in a table that contains all details needed to be compared during data analysis. The table constructed was adapted from Messina et al (2017). This review was designed to systematically summarize all the gathered articles comprising of both quantitative and qualitative methods.…”

“…Previous reviews (Joseph-Williams et al 2014;Messina et al 2017;Sohal et al 2015) mostly discussed diabetes prevention as a whole without focusing on the patients' barriers and lifestyle change facilitators. Therefore, this review focuses on facilitating and hindering factors for diabetic patients to make changes, subsequently providing recommendations for overcoming barriers.…”

Perspektien digitaler Diabetesprävention: wo wollen wir hin?

“…Lebensstilinterventionen, welche körperliche Aktivität und/oder gesunde Ernährung individuell fördern, sind in der Lage, den Blutzucker zu senken [9]. Trotz der ermutigenden Datenlage zeigen Ergebnisse anderer Ziel gruppen , dass vor allem (Hoch-)Risikogruppen von diesen Fortschritten oft nicht profitieren [10]. Beispielhaft können hier repräsentative Ergebnisse der natio nalen KIGGS-Studie (vom Robert Koch-Institut [RKI] durch geführte Studie zur Gesundheit von Kindern und Jugend lichen in Deutschland) zum Gesundheitsverhalten von Kindern und Jugendlichen angeführt werden.…”

Regular dental attendance and periodontal health knowledge: A cross‐sectional survey

“…Primary care clinics seem to be the natural place for health education (International Conference of Primary Health Care, 1978), and patient education-understood as the teaching or training of patients concerning their own health needs (US National Library of Medicine, 2019)-should be an integral part of communication between health providers and patients (Hoving, Visser, Mullen, & Van den Borne, 2010). There are a number of successful experiences of patient education by physicians and their ancillary staff at the primary care level (Messina, Campbell, Morris, Eyles, & Sanders, 2017;Rindner et al, 2017;Sriphanlop, Hennelly, Sperling, Villagra, & Jandorf, 2016), although there is some concern about the knowledge physicians have about oral disorders in general (Rabiei, Mohebbi, Patja, & Virtanen, 2012) and PDs in particular (Varela-Centelles et al, 2018).…”