Background: Diabetes mellitus is one of the most common non-communicable long-term conditions in the world and is linked to high mortality, morbidity, loss of quality of life and high social and economic cost. Diabetes presents a serious health challenge, as it is a significant cause of ill health and premature death. Identification of barriers to self-care is critical for finding ways to reduce the adverse effects of this long-term condition.
Objective: This review identified issues that influence ability to self-care for adults living with diabetes types 1 or 2.
Design: A systematic review of qualitative research studies using the Joanna Briggs Institute (JBI) approach.
Data sources: An electronic search of Health Sciences databases for primary published qualitative studies was conducted April 2011. Reference lists of included articles were reviewed to identify other potential papers.
Review methods: Studies that investigated issues identified by individuals living with diabetes type 1 or 2 that influenced ability to self-care were analysed using a process of meta-aggregation. Meta-aggregation involves the extraction of findings, the synthesis of findings through grouping or aggregating similar findings into themes and labelling with appropriate names and a statement that defines the theme and meta-aggregating the themes into overarching syntheses. Methodological quality was assessed by two reviewers against the JBI quality appraisal criteria for qualitative studies.
Results: Thirty-seven qualitative studies were reviewed. The main issues impacting on an individual's ability to self-care were 'communication', 'education', 'personal factors', 'provider issues' and 'support'. Multiple barriers were found to influence the day-to-day management of diabetes. Key issues related to communication with health care providers, an education programme that allowed for incremental knowledge gain and experiential and vicarious learning and the provision of culturally sensitive care.
Conclusions: People living with diabetes face many issues in their day-to-day management of the disease, compounded by vulnerability to wider situational, cultural and social issues. Self-care ability is a dynamic, evolutionary process that varies from person to person and involves moving from a disease focused existence to maximising life.
Keywords: Barriers; Diabetes mellitus types 1 and 2; Facilitators; Qualitative research; Self-care; Systematic review.
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