Barriers and Limitations to Obstacle Diabetes Self-Management with a Focus on Nutritional Literacy: Solutions and Opportunities. Critical Review and Research Synthesis

Background: Researchers should seek applicable solutions and appropriate opportunities to solve or ravage barriers and limitations that worsen diabetes self-management and outcomes. Objectives: The aim of this critical review and research synthesis was to explore whether the enhancement of nutritional literacy can optimize diabetes self-management and to identify barriers and limitations that obstacle diabetes self-management and to suggest the best available solutions and opportunities that were tailored to eliminate these barriers. Methods: Data sources were PubMed and Medline databases. Studies were authorized if they were in English, used an observational or interventional design and were tailored based on the individual's nutritional knowledge or literacy in diabetes management among patients with diabetes. Databases were searched from February 1988 to December 2018. In order to evaluate the studies' quality, the abstracts that met PICO criteria for qualitative studies underwent dual review for data extraction. A qualitative synthesis was also conducted and the GRADE criteria were used to evaluate the quality of studies. Results: A structured inventory consisted of six constructs (socioeconomic determinants, cultural determinants, education, access to health care services, family structure, and thoughts and personal practices) was designed based on the barriers and limitations. As a result, 151 solutions and opportunities were proposed. Most repeated solutions that were frequently suggested to eliminate the existing barriers, were: “The access to optimal nutrition and health literacy”, “Improved health care services”, “Health policies of governments”, “Sustainable lifestyle-based healthcare system”, “Proper implementation of nutritional intervention programs”, and “Comprehensive culturally sensitive diabetes education, and care programs”. Conclusion: Identification and classification barriers and limitations to obstacle diabetes self-management are critical advances in accomplishing the interventions that can improve optimal diabetes outcomes, for different diabetic societies. Well-designed nutrition literacy intervention programs and preventive procedures may ameliorate the health status in diabetic population.