Sains Malaysiana 48(7)(2019): 1491–1502

http://dx.doi.org/10.17576/jsm-2019-4807-18

Barriers and Enablers to Make Lifestyle Changes among Type 2 Diabetes Patients: A Review

(Halangan dan Pemboleh untuk Mengubah Gaya Hidup Pesakit Kencing Manis Jenis 2: Suatu Kajian Semula)

NORAISHAH MOHAMED NOR, NOR AZWANI MOHD SHUKRI*, NOR QUBBUL AIN MOHD YASSIN, SURIATI SIDEK & NURANIZA AZAHARI

Kulliyyah of Allied Health Sciences, Department of Nutrition Sciences, International Islamic University Malaysia, Kuantan Campus, 25200 Kuantan, Pahang Darul Makmur, Malaysia

Received: 11 February 2019/Accepted: 10 April 2019

ABSTRACT

Type 2 diabetes is a non-communicable disease that affects most people around the world and is generally the result of excessive food intake and physical inactivity. Therefore, the purpose of this review was to identify facilitators and barriers for lifestyle modifications among type 2 diabetes patients. We combined quantitative and qualitative studies for this systematic narrative review. A literary search was carried out using EBSCO, HighWire Press, Medline, PsycInfo, PubMed and Scopus. Narrative review was used to extract results from quantitative studies, while thematic synthesis was used to extract results from qualitative studies. Twenty-three studies were included in this review, with a total of 2287 participants from Western, Arab and Asian populations. The two main themes generated from this review are intrinsic factors and extrinsic factors that can either be facilitators or barriers to implementing lifestyle change. Among the barriers faced by the participants are established food habits, lack of self-efficacy, lack of motivation, lack of social support, inadequate knowledge, low socio-economic status, food culture and poor time management. In contrast, the facilitating factors generated are strong self-efficacy, high motivation, good habits, and sufficient knowledge. In general, patients with diabetes observed more barriers than facilitators to implementing healthy lifestyle changes.

Keywords: Barriers; changes; facilitators; lifestyle; type 2 diabetes

ABSTRAK

Diabetes jenis 2 ialah penyakit kronik tidak berjangkit dan semakin ramai populasi dunia yang menghidapinya. Secara umumnya, pengambilan makanan yang berlebihan dan tidak aktif secara fizikal boleh menyumbang kepada peningkatan bilangan pesakit diabetes. Objektif kajian ini adalah untuk menentukan faktor yang menggalakkan dan menghalang pesakit untuk melakukan perubahan gaya hidup daripada segi pemakanan dan aktiviti fizikal. Untuk kajian naratif sistematik ini, kami menggabungkan kajian kuantitatif dan kualitatif. Kami telah melakukan pencarian literatur menggunakan EBSCO, HighWire Press, Medline, PsycInfo, PubMed dan Scopus. Kajian naratif telah digunakan untuk mengekstrak hasil daripada kajian kuantitatif, sedangkan sintesis tematik digunakan untuk menghasilkan tema daripada kajian kualitatif. Sejumlah dua puluh tiga kajian telah dipilih secara sistematik untuk dianalisis. Jumlah pesakit diabetes yang telibat dalam 23 kajian tersebut adalah seramai 2287 peserta. Dua tema utama yang terbit daripada kajian ini adalah faktor dalaman dan luaran yang boleh menjadi sama ada penggalak atau penghalang untuk membuat perubahan gaya hidup. Antara faktor yang menghalang pesakit diabetes untuk memulakan perubahan gaya hidup adalah tabiat pemakanan, kurang keyakinan diri, kurang motivasi diri, kurang sokongan sosial, kurang pendedahan, status sosioekonomi yang rendah, budaya dan pengurusan masa yang tidak efektif. Faktor yang menggalakkan adalah hampir sama, antaranya adalah keyakinan diri yang tinggi, tabiat pemakanan sihat serta bermotivasi dan pengetahuan yang mencukupi. Secara keseluruhannya, pesakit diabetes mempunyai lebih banyak faktor yang menghalang daripada faktor yang menggalakkan mereka untuk membuat perubahan gaya hidup.

Kata kunci: Diabetes jenis 2; gaya hidup; penggalak; penghalang; perubahan

REFERENCES

ADA. 2003. Physical activity/exercise and diabetes mellitus. Diabetes Care 26(1): 73-77.

Akumiah, P.O., Samuel, O.A., Azumah Nayembil, D., Ofosu Agyapong, G. & Fataw, P. 2017. Barriers to adherence to diet and exercise recommendation amongst Type 2 diabetes mellitus patients. Journal of Health, Medicine and Nursing 39(0): 48-53.

Al-Kaabi, J., Al-Maskari, F., Saadi, H., Afandi, B., Parkar, H. & Nagelkerke, N. 2009. Physical activity and reported barriers to activity among Type 2 diabetic patients in the United Arab Emirates. Review of Diabetic Studies 6(4): 271-278.

Ali, O. 2013. Genetics of Type 2 diabetes. World Journal of Diabetes 4(4): 114-123.

Ashra, N.B., Spong, R., Carter, P., Davies, M.J., Dunkley, A., Gillies, C., Khunti, K., Yates, T. & Youssef, D. 2015. A systematic review and meta-analysis assessing the effectiveness of pragmatic lifestyle interventions for the prevention of Type 2 diabetes mellitus in routine practice about public health england. Public Health England. Wellington House.

Booth, A.O., Lowis, C., Dean, M., Hunter, S.J. & McKinley, M.C. 2013. Diet and physical activity in the self-management of Type 2 diabetes: Barriers and facilitators identified by patients and health professionals. Primary Health Care Research & Development 14(3): 293-306.

Brunk, D.R., Taylor, A.G., Clark, M.L., Williams, I.C. & Cox, D.J. 2017. A culturally appropriate self-management program for hispanic adults with Type 2 diabetes and low health literacy skills. Journal of Transcultural Nursing 28(2): 187-194.

Bryant, T., Leaver, C. & Dunn, J. 2009. Unmet healthcare need, gender, and health inequalities in Canada. Health Policy 91(1): 24-32.

Byers, D., Garth, K., Manley, D. & Chlebowy, D.O. 2016. Facilitators and barriers to self-management of Type 2 diabetes among urban African American adults. Journal of Health Disparities Research and Practice 9(1): 164-174.

Chary, A., Greiner, M., Bowers, C. & Rohloff, P. 2012. Determining adult Type 2 diabetes-related health care needs in an indigenous population from rural Guatemala: A mixed-methods preliminary study. BMC Health Services Research 12: 476.

Chatterjee, S., Khunti, K. & Davies, M.J. 2017. Type 2 diabetes. The Lancet 389(10085): 2239-2251.

Chen, L., Pei, J.H., Kuang, J., Chen, H.M., Chen, Z., Wen Li, Z. & Yang, H.Z. 2015. Effect of lifestyle intervention in patients with Type 2 diabetes: A meta-analysis. Metabolism: Clinical and Experimental 64(2): 338-347.

Chong, S., Ding, D., Byun, R., Comino, E., Bauman, A. & Jalaludin, B. 2017. Lifestyle changes after a diagnosis of Type 2 diabetes. Diabetes Spectrum 30(1): 43-50.

Colagiuri, S., Vita, P., Cardona-Morrell, M., Singh, M.F., Farrell, L., Milat, A., Haas, M. & Bauman, A. 2010. The Sydney diabetes prevention program: A community-based translational study. BMC Public Health 10: 328.

Crandall, J., Schade, D., Ma, Y., Fujimoto, W.Y., Barrett-Connor, E., Flower, S., Dagogo-Jack, S. & Andres, R. 2006. The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes. J. Gerontol. A Biol. Sci. Med. Sci. 61(10): 1075-1081.

Diabetes Prevention Program Research Group. 2011. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. NIH Public Access 374(9702): 1677-1686.

Dixon, A. 2008. Motivation and confidence: What does it take to change behaviour? The Kings Fund. https://doi.org/10.2190/ G8QW-TT09-67PL-QTNC.

Engbers, L.H., Mireille, N.M., Van Poppel, A., Paw, M.C. & Van Mechelen, W. 2006. The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake. BMC Public Health 6: 1-10.

Ezzati, M. & NCD Risk Factor Collaboration. 2016. Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. Lancet (London, England) 387(10027): 1513-1530.

Garrard, J. 2017. Health Sciences Literature Review Made Easy: The Matrix Method. Fifth Edition. Burlington, Massachusetts: Jones & Bartlett Learning.

Ghimire, S. 2017. Barriers to diet and exercise among Nepalese Type 2 diabetic patients. International Scholarly Research Notices 2017: 1273084.

Hankonen, N., Absetz, P., Haukkala, A. & Uutela, A. 2009. Socioeconomic status and psychosocial mechanisms of lifestyle change in a Type 2 diabetes prevention trial. Annals of Behavioral Medicine 38(2): 160-165.

Holman, R.R., Paul, S.K., Bethel, M.A., Matthews, A.A. & Neil, H.A.W. 2008. 10-year follow-up of intensive glucose control in Type 2 diabetes. New England Journal of Medicine 359(15): 1577-1589.

Ide, N., LoGerfo, J.P. & Karmacharya, B. 2018. Barriers and facilitators of diabetes services in Nepal: A qualitative evaluation. Health Policy and Planning 33(4): 474-482.

Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., Salminen, V., Uusitupa, M. & Finnish Diabetes Prevention Study Group. 2001. Prevention of Type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England Journal of Medicine 344(18): 1343-1350.

Jadawala, H.D., Pawar, A.B., Patel, P.B., Patel, K.G., Patel, S.B. & Bansal, R.K. 2017. Factors associated with non adherence to diet and physical activity among diabetes patients: A cross sectional study. Ntl. J. Community Med. 8(2): 68-73.

Joseph-Williams, N., Elwyn, G. & Edwards, A. 2014. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Education and Counseling 94(3): 291-309.

Kaltman, S., Talisman, N., Serrano, A., Cabassa, L.J., Magee, M.F., Pulgar-Vidal, O., Peraza, D. & Cohen, N.R. 2015. Type 2 diabetes and depression: Patient, family member, and primary care provider perspectives on the development of an integrated self-management intervention. The Diabetes Educator 41(6): 763-772.

Kanavos, P., Van Den Aardweg, S. & Schurer, W. 2012. Diabetes expenditure, burden of disease and management in 5 EU countries. LSE Health 1: 1-113.

Khan, A., Al-Abdul Lateef, Z., Al Aithan, M., Bu-Khamseen, M., Al Ibrahim, I. & Khan, S. 2012. Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia. Journal of Family and Community Medicine 19(1): 26-32.

Klein, S., Sheard, N.F., Pi-Sunyer, X., Daly, A., Wylie-Rosett, J., Kulkarni, K. & Clark, N.G. 2004. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: Rationale and strategies. Diabetes Care 27(8): 2067-2073.

Klug, C., Toobert, D.J. & Fogerty, M. 2008. Healthy changes^TM for living with diabetes: An evidence-based community diabetes self-management program cindy. HHS Public Access 6(34): 1053-1061.

Knowler, W.C., Barett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker, E.A. & Nathan, D.M. 2002. Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 346(6): 393-403.

Kolb, H. & Martin, S. 2017. Environmental/lifestyle factors in the pathogenesis and prevention of Type 2 diabetes. BMC Medicine 15(1): 1-11.

Korkiakangas, E.E., Alahuhta, M.A., Husman, P.M., Keinänen- Kiukaanniemi, S., Taanila, A.M. & Laitinen, J.H. 2011. Motivators and barriers to exercise among adults with a high risk of Type 2 diabetes - A qualitative study. Scandinavian Journal of Caring Sciences 25(1): 62-69.

Laranjo, L., Neves, A.L., Costa, A., Ribeiro, R.T., Couto, L. & Sá, A.B. 2015. Facilitators, barriers and expectations in the self-management of Type 2 diabetes - A qualitative study from Portugal. European Journal of General Practice 21(2): 103-110.

Lawton, J., Ahmad, N., Hanna, L., Douglas, M. & Hallowell, N. 2006. I can’t do any serious exercise: Barriers to physical activity amongst people of Pakistani and Indian origin with Type 2 diabetes. Health Education Research 21(1): 43-54.

Lemacks, J., Wells, B.A., Ilich, J.Z. & Ralston, P.A. 2013. Interventions for improving nutrition and physical activity behaviors in adult African American populations: A systematic review, January 2000 through December 2011. Preventing Chronic Disease 10(1): 120256.

Li, G., Zhang, P., Wang, J., Gregg, E.W., Yang, W., Gong, Q., Li, H., Jiang, Y., An, Y., Shuai, Y., Zhang, B., Zhang, J., Thompson, T.J., Gerzoff, R.B., Roglic, G., Hu, Y. & Bennett, P.H. 2008. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing diabetes prevention study: A 20-year follow-up study. The Lancet 371(9626): 1783-1789.

Lindström, J., Peltonen, M., Eriksson, J.G., Hamalainen, H., Ilanne-Parikka, P., Keinanen-Kiukaanniemi, S., Uusitupa, M. & Tuomilehto, J. 2008. Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study. Diabetes Care 31(5): 857-862.

Lindstrom, J., Ilanne-Parikka, P., Peltonen, M., Aunola, S., Eriksson, J.G., Hemio, K., Hamalainen, H., Härkönen, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Mannelin, M., Paturi, M., Sundvall, J., Valle, T.T., Uusitupa, M., Tuomilehto, J. & Finnish Diabetes Prevention Study Group. 2006. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow-up of the Finnish Diabetes Prevention Study. The Lancet 368(9548): 1673-1679.

Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., Uusitupa, M. & Tuomilehto, J. 2003. The Finnish Diabetes Prevention Study (DPS). Diabetes Care 26(12): 3230-3236.

Malik, V.S., Popkin, B.M., Bray, G.A., Despres, J.P., Willett, W.C. & Hu, F.B. 2010. Sugar sweetened beverages and risk of metabolic syndrome and Type 2 diabetes: A meta-analysis. Diabetes Care 33(11): 2477-2483.

Malpass, A., Andrews, R. & Turner, K.M. 2009. Patients with Type 2 diabetes experiences of making multiple lifestyle changes: A qualitative study. Patient Education and Counseling 74(2): 258-263.

Mansyur, C.L., Rustveld, L.O., Nash, S.G. & Jibaja-Weiss, M.L. 2015. Social factors and barriers to self-care adherence in hispanic men and women with diabetes. Patient Education and Counseling 98(6): 805-810.

Marcy, T.R., Britton, M.L. & Harrison, D. 2010. Identification of barriers to appropriate dietary behavior in low-income patients with Type 2 diabetes mellitus. Diabetes Therapy 2(1): 9-19.

Mathew, R., Gucciardi, E., Melo, M.D. & Barata, P. 2012. Self-management experiences among men and women with Type 2 diabetes mellitus: A qualitative analysis. BioMed Central Family Practice 13: 122.

Medagama, A. & Galgomuwa, M. 2018. Lack of infrastructure, social and cultural factors limit physical activity among patients with Type 2 diabetes in Rural Sri Lanka, a qualitative study. PLoS ONE 13(2): 1-8.

Messina, J., Campbell, S., Morris, R., Eyles, E. & Sanders, C. 2017. A narrative systematic review of factors affecting diabetes prevention in primary care settings. PLoS ONE 12(5): 1-20.

Miller, K.M., Beck, R.W., Bergenstal, R.M., Goland, R.S., Haller, M.J., McGill, J.B., Rodriguez, H., Simmons, J.H. & Hirsch, B. 2013. Evidence of a strong association between frequency of self-monitoringof blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care 36(7): 2009-2014.

Moher, D., Liberati, A., Tetzlaff, J. & Altman, D.G. 2009. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology 62(10): 1006-1012. https://doi.org/10.1016/j.jclinepi.2009.06.005.

Norris, S.L., Zhang, X., Avenell, A., Gregg, E., Bowman, B., Schmid, C.H. & Lau, J. 2005. Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: A review. American Journal of Preventive Medicine 28(1): 126-139.

Peimani, M., Monjazebi, F., Ghodssi-Ghassemabadi, R. & Nasli- Esfahani, E. 2017. A peer support intervention in improving glycemic control in patients with Type 2 diabetes. Patient Education and Counseling 101(3): 460-466.

Ratner, R.E. 2006. An update on the diabetes prevention program. Endocr. Pract. 12(2): 105-109.

Riekert, K.A., Ockene, J.K. & Pbert, L. 2014. The Handbook of Health Behavior Change Models. New York: Springer.

Rise, M.B., Pellerud, A., Rygg, L. & Steinsbekk, A. 2013. Making and maintaining lifestyle changes after participating in group based Type 2 diabetes self-management educations: A qualitative study. PLoS ONE 8(5): 1-8.

Roglic, G., Unwin, N., Bennett, P.H., Mathers, C., Tuomilehto, J., Nag, S., Connolly, V. & King, H. 2005. The burden of mortality attributable to diabetes: Realistic estimates for the year 2000. Diabetes Care 28(9): 2130-2135.

Sapkota, S., Brien, J.A.E., Gwynn, J., Flood, V. & Aslani, P. 2017. Perceived impact of Nepalese food and food culture in diabetes. Appetite 113: 376-386.

Savoca, M. & Miller, C. 2001. Food selection and eating patterns: Themes found among people with Type 2 diabetes mellitus. Journal of Nutrition Education 33(4): 224-233.

Seuring, T., Archangelidi, O. & Suhrcke, M. 2015. The economic costs of Type 2 diabetes: A global systematic review. PharmacoEconomics 33(8): 811-831.

Shanti, K. & Aro, A.R. 2018. Barriers and facilitators to physical activity among urban residents with diabetes in Nepal. PLoS ONE 13(6): 1-21.

Sohal, T., Sohal, P., King-Shier, K.M. & Khan, N.A. 2015. Barriers and facilitators for Type 2 diabetes management in South Asians: A systematic review. PLoS ONE 10(9): 1-15.

Sun, Q., Spiegelman, D., van Dam, R.M., Holmes, M.D., Malik, V.S., Willett, W.C. & Hu, F.B. 2010. White rice, brown rice, and risk of Type 2 diabetes in US men and women. Archives of Internal Medicine 170(11): 961-969.

Umeh, A.E. & Nkombua, L. 2018. A study of the knowledge and practice of lifestyle modification in patients with Type 2 diabetes mellitus in middelburg sub-district of Mpumalanga. South African Family Practice 60(1): 26-30.

*Corresponding author; email: norazwani@iium.edu.my