Barriers and enablers to sustaining self-management behaviours after completing a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Abstract

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following completion of a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

“It’s really hard, and if other people say anything else, they’re lying”: A systematic review and qualitative evidence synthesis on barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes

“…A protocol was registered with PROSPERO, the International Prospective Register of Systematic Reviews (Registration number: CRD42021281374) and published (Carvalho et al, 2021). This qualitative evidence synthesis is reported in accordance with the 'Enhancing Transparency in Reporting the Synthesis of Qualitative Research' (ENTREQ) (Tong et al, 2012) (see Supplementary Material 1).…”

“…The search was adapted to suit each database. Details on the process of selection of the databases, and development of the search strategy are presented in the review protocol (Carvalho et al, 2021). In addition, we conducted a backward citation search and forward citation searches on all included articles to identify additional potentially relevant studies (Booth, 2016).…”

“…The eligibility criteria were informed by the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) tool (Cooke et al, 2012) and are described in detail in Supplementary Material 3 and the review protocol (Carvalho et al, 2021).…”

“…Disagreements were discussed between the two authors and when necessary, with a third review team member (JMS), until consensus was achieved. Further details of the screening process are presented in the review protocol (Carvalho et al, 2021).…”

“…PD independently extracted data from 20% of the included studies (n ≈ 2) to ensure consistency and accuracy and minimise potential bias during the data extraction process. Further details on the data extracted and the data extraction process are provided in Supplementary Material 7 and the review protocol (Carvalho et al, 2021).…”