Researchers should seek applicable solutions and appropriate opportunities to solve or ravage barriers and limitations that worsen diabetes self - management and outcomes. Objective s : The ai m of this critical review and research synthesis was to explore whether the enhancement of nutritional literacy can optimize diabetes self - management and to identify barriers and limitations that obstacle diabetes self - management and to suggest the best av ailable solutions and opportunities that were tailored to eliminate these barriers.
Data sources were PubMed and Medline databases. Studies were authorized if they were in English, used an observational or interventional design and were tailored b ased on the individual's nutritional knowledge or literacy in diabetes management among patients with diabetes. Databases were searched from February 1988 to December 2018. In order to evaluate the studies' quality, the a bstracts that met PICO criteria for qualitative studies underwent dual review for data extraction. A qualitative synthesis was also conducted and t he GRADE criteria were used to evaluate the quality of studies.
A structured inventory consisted of six constructs (socioeconomic deter minants, cultural determinants, education, access to health care services, family structure, and thoughts and p ersonal practices) was desi gned based on the barriers and limitations. As a result, 151 solutions and opportunities were proposed. Most repeated solutions that were frequently suggested to eliminate the existing barriers, were: “The access t o optimal nutrition and health literacy”, “Improved health care services”, “Health policies of governments”, “Sustainable lifestyle - based healthcare system”, “P roper implementation of nutritional intervention programs”, and “Comprehensive culturally sensitive diabetes education, and care programs”.
Identif ication and classif ication barriers and limitations to obstacle diabetes self - management are crit ical advances in accomplishing the interventions that can improve optimal diabetes outcomes , for different diabetic societies . Well - designed nutrition literacy intervention programs and preventive procedures may ameliorate the health status in diabetic pop ulation.
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