Objective:
To identify and describe the factors influencing adult diabetes self-management by summarizing the available evidence concerning their types, categories, and relative importance.
Introduction:
Diabetes self-management is influenced by a wide range of factors acting simultaneously and interfering with its actual application by patients. A variety of systematic reviews of these factors exist, however, a more thorough examination of their influences was lacking.
Inclusion criteria:
Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general, or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included.
Methods:
We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (facilitator/barrier, strength and +/− direction of association), categories (eg, demographic, social), and frequency of occurrence.
Results:
We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences came from the categories of psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management.
Conclusions:
Essential components of interventions to promote effective diabetes self-management should aim to help adults deal with the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, since this condition is an especially powerful obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, we encourage researchers to examine non-modifiable factors – age, sex, or socioeconomic status – in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management.
Correspondence: Ketia Alexandre, ketia.alexandre@hesav.ch
The authors declare no conflict of interest.
© 2021 Joanna Briggs Institute.