Barriers and Facilitators to the Delivery of Physical Activity Promotion by Healthcare Professionals for Adults With Type 2 Diabetes: A Mixed-Methods Systematic Review Using the Theoretical Domains Framework

Abstract

Background: Physical activity is an integral component in the treatment and management of Type 2 diabetes. It is recommended that healthcare professionals (HCPs) promote physical activity to patients with Type 2 diabetes; however, they report many challenges to doing this in practice. Aims: This systematic review is aimed at identifying HCPs′ barriers and facilitators to promoting physical activity among adults with Type 2 diabetes. Methods: A mixed-methods systematic review (MMSR) was conducted using a convergent integrated approach, following the Joanna Briggs Institute methodological procedures. MEDLINE, PubMed, PsycINFO, CINAHL, Web of Science and grey literature were searched from 1951 to 2020, with updates in 2024. Studies were excluded if they lacked HCPs′ views on Type 2 diabetes care or were not in English, but no study design restrictions were applied. Barriers and facilitators were coded to the Theoretical Domains Framework (TDF); each domain was ranked for importance, and an inductive thematic synthesis was conducted. Results: A total of 29 primary studies were included in the review. Barriers were reported across 11 TDF domains and facilitators across eight. Key findings within these TDF domains include insufficient time and resources to promote physical activity, a lack of organisational support, lack of knowledge and skills, challenges related to patient comorbidities/complications and HCPs′ perceptions of their roles and responsibilities in promoting physical activity. Conclusions: The findings highlight the need for change at HCP, organisational and environmental levels. Key improvements include clearer roles for promoting physical activity, system-embedded prompts and the integration of disease-specific modules into medical training.