{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:04:09Z","timestamp":1792292649980,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["RP\u2010PG\u20100514\u201020013"],"award-info":[{"award-number":["RP\u2010PG\u20100514\u201020013"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Sustained engagement in type 1 diabetes self\u2010management behaviours is a critical element in achieving improvements in glycated haemoglobin (HbA1c) and minimising risk of complications. Evaluations of self\u2010management programmes, such as Dose Adjustment for Normal Eating (DAFNE), typically find that initial improvements are rarely sustained beyond 12\u00a0months. This study identified behaviours involved in sustained type 1 diabetes self\u2010management, their influences and relationships to each other.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A mixed\u2010methods study was conducted following the first two steps of the Behaviour Change Wheel framework. First, an expert stakeholder consultation identified behaviours involved in self\u2010management of type 1 diabetes. Second, three evidence sources (systematic review, healthcare provider\u2010generated \u2018red flags\u2019 and participant\u2010generated \u2018frequently asked questions\u2019) were analysed to identify and synthesise modifiable barriers and enablers to sustained self\u2010management. These were characterised according to the Capability\u2010Opportunity\u2010Motivation\u2010Behaviour (COM\u2010B) model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>150 distinct behaviours were identified and organised into three self\u2010regulatory behavioural cycles, reflecting different temporal and situational aspects of diabetes self\u2010management: Routine (e.g. checking blood glucose), Reactive (e.g. treating hypoglycaemia) and Reflective (e.g. reviewing blood glucose data to identify patterns). Thirty\u2010four barriers and five enablers were identified: 10 relating to Capability, 20 to Opportunity and nine to Motivation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiple behaviours within three self\u2010management cycles are involved in sustained type 1 diabetes self\u2010management. There are a wide range of barriers and enablers that should be addressed to support self\u2010management behaviours and improve clinical outcomes. The present study provides an evidence base for refining and developing type 1 diabetes self\u2010management programmes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14430","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T09:46:14Z","timestamp":1603100774000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Sustained type 1 diabetes self\u2010management: Specifying the behaviours involved and their influences"],"prefix":"10.1111","volume":"38","author":[{"given":"K.","family":"Hamilton","sequence":"first","affiliation":[{"name":"Centre for Behaviour Change University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5003-8072","authenticated-orcid":false,"given":"S. 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P.","family":"Breckenridge","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Sciences University of Dundee Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1944-7905","authenticated-orcid":false,"given":"D.","family":"Cooke","sequence":"additional","affiliation":[{"name":"School of Health Sciences University of Surrey Guilford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2425-9565","authenticated-orcid":false,"given":"S. R.","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Michie","sequence":"additional","affiliation":[{"name":"Centre for Behaviour Change University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the DAFNEplus study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.13.1709-JMS1004-6-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/berh.2001.0172"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.3.732"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-11-138"},{"key":"e_1_2_8_6_1","unstructured":"National Institute for Health and Care Excellence.Type 1 diabetes in adults: Diagnosis and management. 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