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 changesTM
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
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