Background: Dietary management of type 2 diabetes is considered as a key remission and management strategy. This review explored clinicians’ perceived barriers and enablers to the dietary management of adults with type 2 diabetes in primary care. Methods: MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA were searched from 1980 to 26 June 2020. Results: Of 2021 records, 14 studies met the inclusion criteria, describing the 14 domains of the refined Theoretical Domains Framework. The data synthesised to the domains of environmental context and resources, intentions and beliefs about capabilities were considered most trustworthy, closely followed by knowledge, behavioural regulation and beliefs about consequences. Two-thirds of studies cited time for staff training or patient education as major constraints to type 2 diabetes management. Clinicians also identified lack of patient engagement and poor dietary adherence as issues. Despite this, clinician confidence about giving dietary advice to patients was high. With further exploration, knowledge gaps were apparent and feelings of despondency as a result of poor outcomes were visible. Conclusions: This review revealed four clinician behaviours: (2) the perception of the dietitian; (2) the definition of a clinician qualified to give dietary advice; (3) clinician belief in dietary management as a treatment; and (4) clinician belief in a patient's capability to change dietary behaviour. These behaviours, if challenged and changed, have the potential to improve dietary management and outcomes for people with type 2 diabetes in primary care.
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Outcome specific bias was classified using GRADE as high, moderate, low and very low quality for transparency and simplicity where high was defined as ‘further research is very unlikely to change our confidence …’. For the domains above, and were rated to be of high quality; and were rated as moderate quality; and and rated as low quality. The remaining domains were rated as very low quality based on the internal validity of data within included studies. No conflicts of interest were declared. Gross . and Jansink . benefited from national research monies. Olivarius . part funded their study through the Health Insurance Foundation. 38 environmental context and resources, intentions beliefs about capabilities Knowledge, Behavioural regulation beliefs about consequences Skills Social influences et al 42 et al 14 et al 43
This research was supported by Teesside University. We thank Julie Hogg (Library Services, Teesside University).
© 2021 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.
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