Table 2 Fourth level descriptive themes per outcomes of Self-Management interventions

Knowledge

Insufficient knowledge influences self-management (SM) behaviours

[44, 46, 48, 50, 51, 53, 59, 66, 70, 71, 73, 83].

Knowledge can improve well-being but does not necessarily influence SM behaviours

[44, 47, 49, 57, 59, 74].

Information needs and training preferences are variable

[43, 46, 53, 54, 57, 60, 66, 68, 70, 74, 84, 89, 103].

Traditional health beliefs may explain patients’ understanding of diabetes

[42, 46, 50, 61].

Health literacy

Health literacy allows making informed decisions and accessing health services

[47, 49, 50, 57, 61, 62].

Cognitive representations of the disease determine patients’ SM

[53, 63,64,65)

Patients’ and healthcare professionals’ perspectives on the provision of information are divergent

[45, 46, 60, 65].

Self-efficacy

Low self-efficacy can inhibit self-care leading to a spiral downwards situation

[45, 53, 55].

Tradition and culture influence self-efficacy

[41, 46, 50, 61, 70].

Adequate support and information help to achieve empowerment

[45, 82].

Acknowledgement of patients’ characteristics, diabetes psychological and emotional burden, chronicity of the disease, and treatment complexity may help to increase self-efficacy

[51, 68].

Developing self-efficacy skills can be challenging but, when achieved, enhances self-care

[42,43,44, 53, 55, 85].

Patients with intellectual disabilities and their informal caregivers can gain self-efficacy with flexible and creative support strategies

[89].

Patients’ activation

Active SM requires adopting a diabetic identity taking responsibility, and control

[42,43,44)

Self-care ability develops within the tension between disease and life-centred approaches

[44, 51].

Patients face the challenge of modulating between living in the present and the future

[42, 43].

A low activation level is predicted by personal models or perceived barriers

[44, 48, 52, 54, 56, 57, 59].

Lack of resources and having a passive role in decision-making hinder patient activation

[42, 44, 47, 51, 58].

Adherence to a healthy diet

Abstract Knowledge and practical understanding are crucial for dietary modification

[42, 46, 57, 61, 70, 83, 84].

Healthy diet adherence is challenging and requires self-discipline and proactivity

[41, 43, 46, 57, 61, 66, 85, 86].

Patients’ social contextual factors can act as barriers or facilitators of adherence to a healthy diet

[41, 43, 46, 49, 58, 66, 68, 70, 71, 78, 82].

Tradition over the significance of food may limit dietary modifications

[41, 46, 61, 69, 70].

Western dieting advice contrasts with cultural paradigms of ethnic minorities

[41, 46, 61, 70].

Fear of acquiring the “sick identity” is a barrier to dietary changes

[43, 50].

Physical activity

Patient’s motivation to engage and persist in physical activity is delineated by the expected or experienced benefits rather than Knowledge

[49, 55, 70].

Physical activity persistence requires self-efficacy

[49, 55, 70].

Perceived support influences on patients’ confidence to engage in physical activity

[55, 58, 68, 73)]

Physical impairments usually affect patients’ self-care ability representing barriers to physical activity

[44, 46, 55].

Psychological barriers to physical activity include negative attitudes and negative feelings towards exercise

[48, 51, 55, 70, 86].

Financial constraints and living in an impoverished environment are barriers to physical activity

[44, 46, 70].

Cultural barriers, including beliefs, gender norms, and social rules, can stop patients from engaging in physical exercise

[46, 50, 61, 70, 83].

Environmental factors can limit physical activity

[46, 55, 70].

Adherence to treatment

Medication prescription usually generates negative emotions. However, positive medication experiences can reinforce positive perceptions of medication effects

[52].

Medication adherence requires self-regulation and deliberate effort

[52].

Patients prefer simplified regimens, which can enhance adherence to the treatment

[47, 48, 52, 71, 85, 87].

Patients worry about the perceived medication effectiveness and the risk of adverse events

[52, 70, 71].

Patients can present five patterns of medication-taking behaviours

[52, 85].

Most patients attribute negative features to insulin therapy

[46, 52, 59, 88].

Factors that influence medication-taking behaviours and adherence to treatment are diverse

[46, 47, 50, 56, 58, 59, 61, 70, 71, 78, 83, 85, 87, 88].

Fear of injection, pain and inconvenience of insulin administration are significant barriers to treatment progression to insulin

[46, 52, 56, 59, 85, 90].

Fear of hypoglycaemia and weight gain are associated with reduced adherence to insulin therapy

[52, 56, 59, 90].

Psychosocial factors and stigma can hinder adherence to insulin therapy

[46, 52, 56, 59, 67, 85, 88, 89].

Motivators of compliance with treatment include fear of complications, having comorbidities, awareness of the need for injections, receiving support and having a lower perceived burden

[44, 45, 49, 52, 56, 59, 88, 90].

Self-monitoring

Self-monitoring of blood glucose (SMBG) improves the awareness of the state of health

[43, 46, 47, 59, 63, 66].

Disparate perceptions between patients and HCPs can decrease the efficacy of SMBG

[45, 63].

Barriers to SMBG include misconceptions, problems operating the device, test discomfort, interruption in daily life and a need for family support

[44, 58, 63, 66, 78, 84].

Insulin use influences behaviours toward the monitoring results

[56, 63].

Patients’ responses to self-monitoring are diverse and personal; not all patients are active problem solvers

[56, 63, 75, 86].

(Other) SM behaviours

SM is connected to everyday life where patients’ network is a functional part

[41, 42, 44, 58, 61, 78, 80, 81].

Self-care is defined as an evolving development process that facilitates an optimal self-management

[44].

Context shapes self-management behaviours

[42, 45,46,47,48,49,50].

Establishing a mutual relationship with HCPs is crucial for enhancing SM behaviours

[42,43,44,45, 48, 60].

Having education or training, family support and a great sense of responsibility facilitate engagement in foot self-care

[53, 72].

Patient’s willingness to adopt technology is influenced by independence, perceived improvement in the quality of life and ease of use

[75, 76].

Glycemic control

Negative behaviours and fatalistic beliefs are associated with poor glycaemic control

[50, 54, 81].

Knowing HbA1c values leads to a better understanding of diabetes SM. However, it is not enough to increase confidence and motivation to perform SM activities

[47].

Weight change

Weight concerns influence adherence to treatment

[52, 56, 90].

Social support and patient-HCP interaction have mixed results in weight management

[47, 52, 60].

Competing comorbidities

Originally this outcome was Blood pressure; we extended it to comorbidities.

Simultaneous demands of competing comorbidities, such as back pain, arthritis, asthma, congestive heart failure, chronic obstructive pulmonary disease, fatigue, depression, hypertension and cancer, represent an extra burden for patients and barriers to self-management

[44, 47, 49, 85, 88].

Lipid control

Some patients do not perceive the benefit of taking lipid-lowering medicines

[71].

Some patients are not aware of their increased cardiovascular disease risk

[65].

Long-term complications

Barriers and enablers to retinopathy screening are multi-dimensional, mainly related to environmental context and resources; social influences; Knowledge; memory, attention, and decision processes; beliefs about consequences; and emotions

[64, 73].

Patients’ comprehension of diabetic foot ulceration is often limited or erroneous

[53, 72, 76, 77].

Factors determining foot self-care include specific barriers and facilitators, views over therapeutic footwear, and patients’ attitudes toward taking risks

[53].

Most patients are not satisfied with their foot-related healthcare experiences and demand more holistic care

[53].

The process of discovering and seeking treatment for an ulcer can be prolonged

[53].

Diabetic foot ulceration has a wide-ranging impact on patients’ life

[53].

Telehealth use for diabetic complications improves patient-HCP interactions in self-care

[76, 77].

Self-estimation of risk of cardiovascular complications is variable, with most patients having a low-risk perception

[65].

Hyperglycaemia

Patients do not always acknowledge a causal relationship between hyperglycaemia and symptoms or complications

[46].

Hyperglycaemia is a reason for psychological and emotional distress

[47, 54, 66, 83].

Hypoglycaemia

Hypoglycaemia detection is challenging and may have a disrupting effect on patients’ life

[43, 56, 78].

Fear of hypoglycaemia impacts patients’ SM

[46, 52, 54, 57, 59, 66, 85, 86, 88].

Family support is highly valued in hypoglycaemic events

[58, 78, 84].

Death / Life expectancy

Fatalism is associated with a sense of hopelessness and powerlessness

[41, 50, 53, 56, 65, 70, 71, 86].

Patients have mixed perceptions about the relationship between medicines and death

[59, 71, 88].

Quality of life

A myriad of emotions is related to diabetes diagnosis, experiencing complications and the complexity of SM

[43, 46, 53, 56, 57, 73, 86, 89].

Diabetes threatens how patients identify themselves (their “sense of identity”)

[43, 45, 46, 53, 80].

Social support is crucial to SM, but in some cases, it can be perceived as an interference

[44, 46,47,48,49, 53,54,55, 57, 58, 70, 73, 78, 80, 84, 88].

Stigma related to diabetes diagnosis, treatment and complications is frequent and hinders SM

[41, 46, 56, 71, 73, 85, 89, 91].

Experience of care

Patients prefer individualised care over a generic one

[43, 45, 49, 60, 63, 66, 74].

The patient-healthcare professional relationship can be paternalistic or collaborative

[46, 51, 53, 60, 66, 67].

Despite valuing emphatic interactions, patients usually face criticism and blame for them

[44, 53, 54, 60, 67].

Cultural appropriateness shapes the experience of care

[46, 50, 54, 67,68,69,70].

Patients are usually willing to use technology

[74, 75]

Patients are usually satisfied with the adoption of technology

[76]

Decision-making process

Patients and HCPs have a divergent agenda

[42, 56, 60]

The quality of communication influences the decision-making process

[53, 60, 67, 71, 72).

Culture shapes preferences for the decision-making process

[54, 67, 70]

Lack of time is a common issue affecting patient-professional communication

[42, 53, 54, 60, 67, 70]

Scheduled care

Difficulties getting to the appointment

[49, 61, 70]

If patients do not feel heard, they might not return

[60, 66]

The cultural background might be a reason for delaying consultations

[61, 71]

The experiences with primary health care professionals influence attendance to specialist appointments

[42, 64, 73]

The process of accessing specialised care is perceived as difficult

[64, 73]

Access to specialised care is influenced by setting and cultural background

(73).

Value for money of SM

Type of insurance influences diabetes treatment

[41, 42, 47, 53, 62, 71, 85]

Diabetes may have an impact on patients’ and informal caregivers’ finances

[56, 84]

Patients’ finances may have an impact on disease management

[41, 42, 44, 47,48,49, 61, 70, 72, 76, 77, 83, 88]

Telehealth care is perceived positively from a financial point of view

[56, 84]