It's really hard, and if other people say anything else, they're lying": A systematic review and qualitative evidence synthesis on barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes

Attendance at self-management support interventions is associated with improved outcomes in people living with type 2 diabetes. However, people often struggle to sustain changes to self-management behaviours post-intervention. This review aimed to identify and synthesise qualitative research on barriers and enablers to sustaining type 2 diabetes self-management behaviours after attending a self-management intervention. Eight electronic databases were searched to identify potentially relevant peer-reviewed and grey literature studies. Using the “best fit” framework synthesis approach, data were deductively coded to the five behaviour change maintenance-relevant theoretical themes (maintenance motives, habits, resources, self-regulation, environmental and social influences) and 14 constructs identified by Kwasnicka and colleagues (2016). Data that did not fit these themes or constructs were analysed using inductive thematic analysis. Eleven articles reporting on 10 studies were included. Twenty-eight barriers and enablers were coded to the five a priori themes. Five constructs were removed, and three new constructs and 12 sub-constructs were incorporated into an adapted framework. Barriers were most commonly coded to the themes self-regulation, resources, and environmental and social influences. Enablers were most commonly coded to the themes habits and maintenance motives. Six evidence-based recommendations for interventions to better support sustained engagement in self-management behaviours are outlined.