Table 3 Summary of barriers to accessing dSSP and design related solutions

Health literacy, digital literacy, English as a second language, cognitive impairment

Composition:

Syntactic structure

Use of tools designed to improve readability and navigation for those with lower (health) literacy [43, 44].

Use input of target diabetes population in the creation of written materials [45, 46] and incorporate their preferences and use the perspectives of patients from the target populations [33]

Composition:

Graphic User Interface

Use tools designed to improve usability of electronic interfaces [47, 48].

Appropriate combination of graphics, icons, and written elements and for diabetes patients in underserved populations quick access to information on glycaemic control, physical activity [49]

Inaccessible locations, unsuitable times

Structure:

Duration and location

The use of community-based locations and a range of times [50,51,52]. mHealth can improve access [53,54,55] but with preferences for the use of portable technology [56] that can still be used offline [55].

Flexible programmes running for a number of sessions and varying in frequency of contact with facilitators have proven successful [57–[60]

The conflict between the benefits of shared experience of group sessions and the reluctance to identify with diabetes.

Structure:

Group or individual sessions

Flexibility to meet preferences for individual or group sessions [61–[63]

The design and delivery of individual elements and/or the complexity of SSPs containing multiple elements

Structure:

Syllabus

Preferences for content more relevant to their everyday lives [49, 64].

Creating SSPs with no more than three instructional elements [65].

The lack of awareness of health care professionals as to the importance of self-management

Facilitator:

Health care professional

Use clearer marketing strategies, more effective referral pathways, and closer collaborations with clinicians [66].

Lack of understanding of personal circumstance

Facilitator:

Peer supporters

Evidence of benefits for lifestyle behaviours [67, 68], reassurance [69] and accessing a range of underserved communities [70,71,72,73].

Lack of integration with community resources and local settings

Facilitator:

Community-based

health workers

Benefits of using CHWs included increased physical activity, improved dietary behaviours, glycaemic control [55, 58, 60, 74, 75] including amongst the elderly [76]. Also reported were the benefits of using community pharmacies [77]

Multiple demographic and socio-cultural influences on health engagement

Context:

Individual

Use a range of validated tools to discern patient experiences and preferences [78,79,80]. Advantages of individual tailoring of education packages [81] and facilitators to patient preferences [82].

Context:

Socio-cultural

Advantages reported of tailoring SSP to reflect cultural needs and preferences at the population level [83,84,85]. A greater reliance on community educators, one-on-one interventions, visual information, alternative languages, and social support [86, 87].

The necessary resources, training, and processes specific to embedding SSP in health economies

Context:

Health system

Increasing awareness of importance of SSP and maintenance of self-management skills amongst clinicians [88,89,90,91]

and how socio-cultural influences impact self-management behaviours [85].

Realign targets to address the challenges reaching underserved populations, [92] build relationships with local groups at senior level [93].