Abstract

BackgroundDiabetes has become a global health emergency affecting high-, middle- and low-income countries. Previous systematic reviews have either focused on patients’ adherence to diabetes self-care behaviours only or barriers to diabetes care (including self-care) only in the published literature and have not also analysed data separately for low- and middle-income countries (LMICs). Thus, none have focused on adherence with, and barriers to, self-care behaviours from the perspectives of both patient and providers in low- and middle-income countries (LMICs). This systematic review will evaluate the published literature on adherence to five diabetes self-care behaviours (i.e., diet, exercise, self-monitoring of blood glucose, medication taking and foot care) and associated barriers in type 2 diabetes patients in LMICs. Healthcare providers’ barriers to the provision of diabetes self-care support will also be reviewed.MethodsThis narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, MEDLINE, EMBASE, CINAHL, SCOPUS, PsycINFO, Cochrane Library and the British Nursing Index will be searched. Qualitative and quantitative studies reporting on type 2 diabetes patients’ adherence to self-care behaviours and associated barriers in LMICs will be included. Studies also reporting on barriers encountered by providers in LMICs providing diabetes care and supporting patients to adhere to self-care behaviours will also be included. Cross-sectional studies, observational cohort studies, baseline data of randomised controlled trials and qualitative studies will be eligible. Two independent reviewers will screen articles for inclusion, undertake quality assessment of included studies and execute data extraction using standardised forms. Discrepancies will be discussed to reach consensus, and another reviewer will adjudicate if the need arises. The Guidance of Narrative Synthesis in Systematic Reviews will be employed to explore relationships within and between included studies.DiscussionThis review will provide evidence on adherence to self-care behaviours by type 2 diabetes patients in LMICs. Barriers experienced by patients in LMICs to adhere to recommended self-care behaviours will also be identified. Barriers experienced by healthcare providers in LMICs in providing self-care support patients will also be determined.Systematic review registrationPROSPERO CRD42016035406

Highlights

  • MethodsThis narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P)

  • Diabetes has become a global health emergency affecting high, middle- and low-income countries

  • As each of these behaviours is important to health outcomes, it is essential to have a clear understanding of the level of adherence to each self-care behaviour and barriers to the performance of each of them for low- and middle-income countries (LMICs)

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Summary

Methods

This systematic review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 [20]. Qualitative studies will be assessed according to quality assessment categories adopted by Popay, Rogers and Williams [28] These categories will pertain to relevance and appropriateness of research design, study context, use of convenience/purposive sampling, richness of data, thoroughness of data analysis and clarity of interpretation and logical generalisation of findings based on theoretical underpinnings. This tool has been used widely for assessing the quality of qualitative studies in several systematic reviews [29,30,31]. VM will conduct the synthesis in consultation with the rest of the review team members

Discussion
Background
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