Table 4 Recommendations for Policy, Practice and Future Research

Patients require personal adjustments to accept the diagnosis and deal with treatment

• Develop programmes that include psychological interventions for patients with recently diagnosed T2DM.

• Provide close support during the early stages of T2DM diagnosis.

Patients with low numeracy or literacy skills can find it difficult accessing to healthcare services

• Include patients in the research and development of educational programmes or materials to test their comprehension and usability.

• Facilitate materials considering numeracy and literacy differences.

Patients value highly educational interventions that answer their information needs and have considered their training preferences and beliefs on health

• Incorporate a culturally sensitive approach in SMI development.

• Reinforce strategies for positive patient-HCP relationships and understanding what matters most to patients.

• Provide tailored messages according to patients’ characteristics and context.

Engaging in SMIS is possible with shared decision-making

• Reinforce programs for effective communication.

• Develop a culturally sensitive mindset in the healthcare organization.

• Include patients in their care decisions to find a common agenda.

• Avoid time pressures as much as possible Try different modalities for scheduling visits according to patients’ requirements, e.g., more frequent visits.

Medication adherence is perceived as requiring self-regulation and deliberate effort.

Fear is always present in treatment adherence.

Fear of hypoglycaemia and weight change may hinder treatment adherence.

• Offer alternatives that allow patients to adapt treatment to their activities, preferring simplified regimens.

• Offer a self-paced process of incorporation of treatment.

• Support patients with difficulties, solve doubts about treatment effectiveness, and how to face eventual complications.

Patients do not readily perceive the risk of long-term complications.

• Educate patients about the silent progress of diabetes when it is not controlled.

Quality of life constraints and physical and psychological barriers can make it challenging to follow SM. In some cases, they perceive or experience diabetes stigma.

• Identify early patients at higher risk of not getting support to face diabetes psychological and emotional burden.

• Facilitate or develop programs to help patients deal with the changes in adapting to diabetes.

Most patients find it more feasible to adhere to a healthy diet when they have practical Knowledge regarding diet and cooking, develop self-discipline, become more proactive, and have social support.

• Provide practical tips for diet and cooking.

• Inquire about their level of social support when dealing with adherence to a healthy diet.

Patients find it easier to engage and continue with physical activity when they perceive having social support, having experienced benefits from exercise or having reasonable expectations, and gaining self-efficacy.

• Help to set reasonable goals with physical activity programs.

• Inquire about their level of social support to start and continue with physical activity.

Talking to peers and sharing experiences is an essential source of emotional support and facilitates SM integration in their daily life.

• Recommend participating in peer-support groups for patients with diabetes and related complications.