title: Adherence to self-care behaviours and associated barriers in type 2 diabetes patients of low-and middle-income countries: a systematic review protocol.
abstract: Diabetes has become a global health emergency affecting high-, middle- and low-income countries. Previous systematic reviews have either focused on patients' adherence to diabetes self-care behaviours only or barriers to diabetes care (including self-care) only in the published literature and have not also analysed data separately for low- and middle-income countries (LMICs). Thus, none have focused on adherence with, and barriers to, self-care behaviours from the perspectives of both patient and providers in low- and middle-income countries (LMICs). This systematic review will evaluate the published literature on adherence to five diabetes self-care behaviours (i.e., diet, exercise, self-monitoring of blood glucose, medication taking and foot care) and associated barriers in type 2 diabetes patients in LMICs. Healthcare providers' barriers to the provision of diabetes self-care support will also be reviewed.
  
  
  
  This narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, MEDLINE, EMBASE, CINAHL, SCOPUS, PsycINFO, Cochrane Library and the British Nursing Index will be searched. Qualitative and quantitative studies reporting on type 2 diabetes patients' adherence to self-care behaviours and associated barriers in LMICs will be included. Studies also reporting on barriers encountered by providers in LMICs providing diabetes care and supporting patients to adhere to self-care behaviours will also be included. Cross-sectional studies, observational cohort studies, baseline data of randomised controlled trials and qualitative studies will be eligible. Two independent reviewers will screen articles for inclusion, undertake quality assessment of included studies and execute data extraction using standardised forms. Discrepancies will be discussed to reach consensus, and another reviewer will adjudicate if the need arises. The Guidance of Narrative Synthesis in Systematic Reviews will be employed to explore relationships within and between included studies.
  
  
  
  This review will provide evidence on adherence to self-care behaviours by type 2 diabetes patients in LMICs. Barriers experienced by patients in LMICs to adhere to recommended self-care behaviours will also be identified. Barriers experienced by healthcare providers in LMICs in providing self-care support patients will also be determined.
  
  
  
  PROSPERO CRD42016035406.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia. vmogre@uds.edu.gh.|Department of Health Professions Education, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana. vmogre@uds.edu.gh.
authors.forename: Victor
authors.identifier: 0000-0003-0230-5783
authors.initials: V
authors.lastname: Mogre
authors.affiliation: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.|Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Johnson
authors.affiliation: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.|Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.|Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.
authors.forename: Flora
authors.initials: F
authors.lastname: Tzelepis
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shaw
authors.affiliation: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.|Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Paul
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D000078202:Systematic Reviews as Topic
keywords: Adherence; Barriers; Low- and middle-income countries; Self-care; Type 2 diabetes