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

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.背景：全球范围内，2型糖尿病（Type 2 diabetes）正影响着数百万人群的健康，但通过生活方式调整与干预手段，多数未来新发病例可得到预防。基层医疗（primary care）是针对糖尿病高危人群开展预防工作的重要场景：一方面，基层医疗是患者接触医疗体系的首要渠道；另一方面，医护人员可在此提供生活方式咨询与支持，同时监测健康结局，上述要素均为糖尿病高危成人预防工作的核心内容。 研究目的：本研究旨在明确高收入国家基层医疗场景中，与2型糖尿病预防干预措施的实施与采纳相关的各类影响因素。 研究方法：本研究为叙述性系统综述（narrative systematic review），纳入针对糖尿病高危人群在基层医疗场景中开展糖尿病预防工作的定性与定量研究。研究采用迭代式证据收集方法，通过多个数据库（医学文献联机数据库（MEDLINE）、荷兰医学文摘数据库（Embase）、心理学文摘数据库（PsycINFO）、英国护理索引（BNI）、社会科学引文索引（SSCI）、护理及相关健康文献累积索引（CINAHL）、应用社会科学索引与文摘（ASSIA））检索文献，检索策略为将糖尿病相关术语与基层医疗相关术语进行组合。本研究采用叙述性与主题合成法，以识别数据中浮现的核心研究主题。 研究结果：研究团队共筛选出6646条文献记录，最终纳入18篇文献。本综述共识别出三大核心主题：第一大主题为糖尿病进展的相关背景与场景，涵盖糖尿病的发病风险与进展、基层医疗作为预防场景的定位，以及各方对变革责任的认知；本综述同时发现，学界对基层医疗中预防服务的价值存在分歧。第二大主题聚焦与糖尿病预防相关的各类患者层面因素，包括患者调整现有生活方式的动机、对糖尿病危害的认知与了解（或认知缺失）、医疗场景中随访机制的缺失，以及对医护人员的信任程度。第三大主题围绕影响糖尿病预防工作的医护人员层面因素展开，包括工作负荷、时间限制、资源储备、自我效能与专业知识，以及医护人员对患者变革动机的认知。 结论：本综述探讨了基层医疗场景中影响糖尿病预防工作的各类因素，明确了预防工作的相关背景，以及与基层医疗中预防服务提供相关的患者与医护人员层面因素。本系统综述通过聚焦预防工作中的关键影响因素，补充了现有针对真实世界场景的相关综述研究；其研究结果可为致力于了解糖尿病预防干预措施实施与采纳相关影响因素的学者、政策制定者、患者及从业者提供有价值的参考。