Understanding the role of health beliefs amongst adults engaging with secondary and tertiary preventive services to live well with type 2 diabetes: a rapid review 

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Introduction

Type 2 diabetes is increasing in Wales, but many people do not take part in prevention or management programmes, limiting health benefits and adding pressure on NHS services.

We carried out a rapid review using the Health Belief Model to understand why people choose to engage, or not engage, with:

• Tertiary prevention programmes for people with type 2 diabetes, including screening and education to prevent complications.
• Secondary prevention programmes for people with pre‑diabetes, such as diabetes prevention programmes.

Main points

How up to date is this evidence?

We carried out the searches for this review in July/August 2024 for studies published from 2000 onwards. We identified studies that were published between 2008 and 2014.

What we found

• We identified 15 studies: 10 on programmes for people with prediabetes (secondary prevention) and 5 on programmes for people with type 2 diabetes (tertiary prevention).
• Secondary prevention (prediabetes)
  • People were more likely to take part when they understood their personal risk, believed prediabetes could be reversed, and felt confident about making changes. Clear explanations from professionals, supportive group settings, and noticing small health improvements also helped people stay motivated.
  • Barriers included practical difficulties (timing, travel, costs), other health conditions, discomfort with group formats, and unclear or discouraging communication from professionals. Engagement improved when advice was straightforward, family and friends were encouraging, and people received regular check‑ins.
• Tertiary prevention (type 2 diabetes)
  • Engagement in screening and education programmes increased when people understood the seriousness of diabetes complications and felt reassured and well‑supported by healthcare staff. Practical knowledge and peer support also encouraged continued involvement.
  • Barriers included unclear information, difficulties getting to appointments, unsuitable venues, long sessions, and discomfort with certain procedures like eye‑dilating drops. Some people worried about being judged, while others felt they already knew enough and did not see the need to attend.

What this means?

• Clear, supportive conversations may help people understand their risks and feel confident about joining services.  Simple explanations could make information about prediabetes and complications less overwhelming. Conversations may work better than letters; and a follow‑up invitation may help unsure individuals.
• Support works best when linked to people’s own goals. Offering small steps, encouragement and feedback may help when confidence is low. Regular check-ins, and peer support can help maintain engagement. However, some people prefer to self-manage, so offering this option is important.
• Offering flexible formats (digital or in‑person, group or one‑to‑one), community venues and clear information about travel and costs may reduce barriers and keep people engaged.
• Evidence for tertiary prevention was limited and covered only a few service types, so findings may not apply widely. And there was very little evidence from people who do not attend services, which limits what we can say about why people choose not to engage, limiting our understanding of non‑engagement.
• Evidence gaps remain for digital delivery, and experiences of ethnic minority groups.

Technical information

We carried out a rapid review using streamlined yet rigorous systematic review methods to find and summarise evidence. We included studies from the UK and Ireland published in English after 2000 that explored health beliefs and engagement with diabetes prevention or management services. Because perceptions have changed over time, earlier studies were excluded. Findings were summarised as reported by the original authors, and we interpreted them using the Health Belief Model to bring together common themes.

Glossary

Prediabetes: Also known as borderline diabetes, is a condition where blood glucose levels are above normal but below diabetes (typically HbA1c 42 to 47 mmol/mol), indicating a high risk of type 2 diabetes.

Secondary prevention: Emphasises early disease detection by identifying disease before symptoms have progressed and stopping the disease worsening, if possible. For example, support to stop prediabetes turning into type 2 diabetes.

Tertiary prevention: Action to help people manage symptoms and prevent further disease progression once the disease has already developed. For example, support for people with diagnosed type 2 diabetes to stop complications from developing.

Health belief model: A framework for understanding why people do or don’t take up health services. It focuses on beliefs about risk (susceptibility), seriousness (severity), benefits, barriers, plus cues to action and self‑efficacy (confidence).

Peer support: Is supported self-management intervention where people with shared lived experience of a long-term condition or health experiences, support each other (one‑to‑one, groups, or online) to build confidence, problem‑solve, and reduce isolation.

Rapid review: Is a form of evidence synthesis that accelerates the process of conducting a traditional systematic review to produce evidence in a time-sensitive manner, usually to inform urgent healthcare decisions.

Systematic review: A review that summarises the evidence on a clearly formulated review question according to a predefined protocol, using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, analyse, collate and report their findings. It may or may not use statistical techniques, such as meta-analysis.