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Individual, healthcare professional and system-level barriers and facilitators to initiation and adherence to injectable therapies for type 2 diabetes: A systematic review and meta-ethnography.

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journal contribution
posted on 2021-10-01, 10:11 authored by Jo Byrne, Andrew Willis, Alison Dunkley, Claire Fitzpatrick, Sandra Campbell, Manbinder S Sidhu, Pratik Choudhary, Melanie J Davies, Kamlesh Khunti
Aims
To review and synthesise the contemporary qualitative evidence, relating to the individual, healthcare professional and system-level barriers and facilitators to injectable therapies in people with type 2 diabetes, and evaluate (using an intersectional approach to explore the diverse perspectives of different identities) whether views have changed with treatment and guideline advancements.

Methods
A meta-ethnography approach used. Eight databases searched from the years 2006 (GLP-1 analogues introduced) to February 2021. Study selection (using a pre-defined inclusion criteria), quality appraisal and data extraction, conducted independently by two reviewers.

Results
Screened 7143 abstracts, assessed 93 full-text papers for eligibility and included 42 studies—using data from 818 individuals with type 2 diabetes and 160 healthcare professionals. Studies covered a diverse range of views from healthcare professionals and individuals, including those relating to older adults and people from ethnic migrant backgrounds, and 10 studies rated moderate to strong research value. Key themes abstracted: barriers (physical/psychological/social) and facilitators (motivation/capability/opportunity).

Conclusions
The first synthesis of contemporary qualitative data to adopt an intersectionality approach and explore diverse views relating to barriers and facilitators that influence engagement with injectable treatments for type 2 diabetes. A model is presented to help patients, health practitioners and policy makers identify barriers and facilitators and understand the complex interplay of physical, psychological and social factors involved when prescribing injectable therapies. Despite advances in injectable treatments and guidelines, findings highlight the many barriers that still exist and show how strongly held culturally-specific health beliefs of people from diverse socio-economic and ethnic backgrounds can become substantial obstacles to treatment.

Funding

National Institute for Health Research

History

Citation

Diabetic medicine, https://doi.org/10.1111/dme.14678

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

  • AM (Accepted Manuscript)

Published in

Diabetic Medicine

Publisher

Wiley

issn

0742-3071

eissn

1464-5491

Acceptance date

2021-08-24

Copyright date

2021

Available date

2022-08-25

Language

eng

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