Barriers and enablers to screening and diagnosing diabetes distress and depression in people with type 2 diabetes mellitus: A qualitative evidence synthesis

Published:August 23, 2021DOI:


      • Captured GP, practice nurse and chronic disease nurse perspectives.
      • Barriers and enablers regarded T2DM, health professional and health system factors.
      • Most, but not all barriers and enablers were discussed by GPs and nurses.
      • One barrier and 2 enablers were assessed as findings of high confidence.



      Synthesise qualitative evidence of healthcare professionals’ (HCP) experiences of diabetes distress and depression screening in people with type 2 diabetes (T2DM) in primary care to identify HCP barriers and enablers to screening implementation.


      Searched six electronic databases in October 2020 for qualitative studies exploring HCPs’ experiences of diabetes distress and depression screening in T2DM populations. Applying a best-fit framework synthesis, data were coded to the theoretical domains framework (TDF), followed by thematic analysis of data that did not fit the TDF. Study quality and confidence in findings were assessed using CASP and GRADE-CERQual respectively.


      Of 4942 unique records identified, 10 articles were included. We identified fifteen barriers and enablers in 8 TDF domains and 1 new domain; people with T2DM factors. One barrier (poor awareness about the rationale for screening) and 2 enablers (perceived impacts on T2DM care, receiving financial reimbursement) were assessed as findings of high confidence.


      HCPs experience many barriers and enablers to diabetes distress and depression screening among people with T2DM in primary care. Future interventions and policies should ensure HCPs understand the rationale for screening, highlight the benefits of screening, resource screening appropriately and address HCP group specific barriers.


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