Work

An Umbrella Review of Barriers and Facilitators to Medical Nutrition Therapy in Primary Healthcare for People with Diabetes

Year: 2026

Type: article

Abstract: CONTEXT: The provision of Medical Nutrition Therapy (MNT) is recommended as a component of best practice care for the management of diabetes. OBJECTIVES: The objectives of this umbrella review were to: (1) Describe the characteristics of the reviews identified and included in the review, (2) identify re-occurring (in ≥3 reviews) themes related to barriers and facilitators for healthcare professionals providing and patients living with diabetes receiving MNT for diabetes management, and (3) map these identified factors to the Capacity, Opportunity, Motivation-Behavior Wheel (COM-B) model and the Theoretical Domains Framework (TDF). The COM-B model assumes an individual's behavior change is dependent on 3 elements: capability, opportunity, and motivation. The TDF identifies 14 behavior change factors that are influenced by the 3 elements of the COM-B model. DATA SOURCES: A search of the literature was conducted using 4 databases for reviews published from inception to July 2023. Reviews that met the following criteria were included in the review: Sample: adults living with diabetes, GPs, clinicians or dietitians; Phenomena of interest: MNT; Design: Systematic reviews, reviews of reviews, meta-analyses; Evaluation: Perceived barriers and facilitators for providing or receiving MNT in primary care; Research type: quantitative, qualitative, or mixed-methods research. DATA EXTRACTION: Two independent reviewers completed the data extraction. Identified barriers and facilitators were mapped to the COM-B model and TDF. DATA ANALYSIS: Of 294 articles that were identified from the literature search strategy, 7 reviews were included. Most reviews (5 of 7) had ≥90% of the included studies from high-income countries. The patient "barrier" themes identified were time constraints and negative interactions with healthcare professionals, while the "facilitator" theme included positive interactions with the health service and providers. For healthcare professionals, the "barrier" themes identified were time constraints, limited resources, and miscommunication, while "facilitator" themes were having confidence in providing dietary advice and involving patients in clinical decisions. CONCLUSION: To improve the provision of MNT for adults with diabetes, interventions are required that target the TDF domain: Environment Context and Resources. Ensuring that patients understand what is provided from dietetic services and that they receive a referral to consult with a dietitian will be important for supporting the provision of MNT in clinical practice. These review findings are only relevant in the context of high-income countries, and further research is needed in low- and middle-income countries. UMBRELLA REVIEW REGISTRATION: OSF Preregistration. https://osf.io/hm7qp.

Source: Nutrition Reviews

DOI: 10.1093/nutrit/nuag033

Authors: Rachael M Taylor, Tracy L Burrows, Emma E Bone, Roberta C Asher, Clare E Collins

Institutions: Hunter Medical Research Institute, University of Newcastle Australia, John Hunter Hospital, Hunter New England Local Health District

Language: English

Topic: Diabetes Management and Education

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,981