{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:06:59Z","timestamp":1791929219434,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":188,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>When oral antidiabetic drugs are insufficient to achieve glycemic control in Type 2 diabetes mellitus (T2DM), patients face the decision of whether to initiate insulin therapy. Patient decision aids (PtDAs) facilitate shared decision\u2010making (SDM) by supporting informed, preference\u2010congruent choices about insulin initiation. However, PtDA implementation in China remains challenging, with limited understanding of context\u2010specific barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study is aimed at identifying the barriers and facilitators to implementing PtDAs for supporting informed decisions about insulin initiation in T2DM management in China, from the perspectives of key interest holders (patients, endocrinologists, nurses).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive study was conducted using semistructured interviews guided by the Theoretical Domains Framework (TDF). A purposive sample of 26 participants (10 patients with T2DM, 6 physicians, and 10 nurses) was recruited from a university\u2010affiliated hospital in Beijing. Interviews were audio\u2010recorded, transcribed verbatim, and analyzed using a framework analysis approach assisted by NVivo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen barriers and five facilitators were identified for healthcare professionals, whereas six barriers and five facilitators were identified for patients. Key barriers included a lack of knowledge about PtDAs and insufficient skills for their use among both groups. Notable barriers related to social\/professional role and identity were found, with physicians often self\u2010identifying as sole \u201cdecision\u2010makers\u201d and nurses expressing role ambiguity regarding SDM. The absence of reinforcement mechanisms and concerns about increased workload and limited resources were substantial organizational barriers. Facilitators included positive beliefs about PtDAs\u2032 consequences and the readiness of nurses, whose established health education practices position them as potential champions for implementation. Patients demonstrated a positive intention to use PtDAs once their purpose was understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The implementation of a PtDA for informed decision\u2010making about insulin initiation in T2DM patients in China is influenced by a complex array of factors. Moving beyond the common barrier of time constraints, this study highlights foundational gaps in knowledge, skills, and role alignment as primary hurdles. A multifaceted implementation strategy is essential, comprising comprehensive education and training, clear role delineation, adaptation of PtDAs to fit clinical workflows, and strong organizational commitment with integrated monitoring and support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jdr\/2842572","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:32:07Z","timestamp":1783503127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementing Patient Decision Aids for Insulin Initiation in China: What are the Barriers and Facilitators? A TDF\u2010Based Qualitative Study"],"prefix":"10.1155","volume":"2026","author":[{"given":"Dan","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0091-370X","authenticated-orcid":false,"given":"Hongzhan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-1695","authenticated-orcid":false,"given":"Meiqi","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanting","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiou","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7533-8183","authenticated-orcid":false,"given":"Xuejing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9038-6212","authenticated-orcid":false,"given":"Yufang","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_2_15_1_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m997"},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3158"},{"key":"e_1_2_15_4_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S011"},{"key":"e_1_2_15_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2016.1231932"},{"key":"e_1_2_15_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0034"},{"key":"e_1_2_15_7_2","first-page":"16","article-title":"Chinese Guideline for the Prevention and Treatment of Diabetes (2024 Edition)","volume":"17","author":"Chinese Diabetes Society","year":"2025","journal-title":"Chinese Journal of Diabetes"},{"key":"e_1_2_15_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-12160-z"},{"key":"e_1_2_15_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2077-6"},{"key":"e_1_2_15_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38926.629329.AE"},{"key":"e_1_2_15_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-025-09707-z"},{"key":"e_1_2_15_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2025.02.003"},{"key":"e_1_2_15_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001431.pub6"},{"key":"e_1_2_15_14_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2004.tb05948.x"},{"key":"e_1_2_15_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jpm.13011"},{"key":"e_1_2_15_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1162993"},{"key":"e_1_2_15_17_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S335080"},{"key":"e_1_2_15_18_2","volume-title":"Construction of a Decision Aid Tool for Insulin Initiation and Intervention Strategies in Chinese Patients With Type 2 Diabetes","author":"Yang D.","year":"2025"},{"key":"e_1_2_15_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37"},{"key":"e_1_2_15_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-022-02030-2"},{"key":"e_1_2_15_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/nur.21768"},{"key":"e_1_2_15_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"e_1_2_15_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444"},{"key":"e_1_2_15_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-018-0594-7"},{"key":"e_1_2_15_25_2","doi-asserted-by":"publisher","DOI":"10.7748\/nr2011.01.18.2.52.c8284"},{"key":"e_1_2_15_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9"},{"key":"e_1_2_15_27_2","article-title":"Competing Paradigms in Qualitative Research","volume":"2","author":"Guba E. G.","year":"1994","journal-title":"Handbook of Qualitative Research"},{"key":"e_1_2_15_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-3-57"},{"key":"e_1_2_15_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0731-z"},{"key":"e_1_2_15_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-095360"},{"key":"e_1_2_15_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.zefq.2017.05.004"},{"key":"e_1_2_15_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-13-S2-S14"},{"key":"e_1_2_15_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2013.09.018"},{"key":"e_1_2_15_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1744"},{"key":"e_1_2_15_35_2","doi-asserted-by":"publisher","DOI":"10.7748\/ns.29.31.50.e8570"},{"key":"e_1_2_15_36_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.10.2543"},{"key":"e_1_2_15_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0094670"},{"key":"e_1_2_15_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-13-S2-S11"},{"key":"e_1_2_15_39_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004565.pub2"},{"key":"e_1_2_15_40_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1078"},{"key":"e_1_2_15_41_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0784-z"},{"key":"e_1_2_15_42_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2007.00478.x"}],"container-title":["Journal of Diabetes Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jdr\/2842572","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/jdr\/2842572","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/jdr\/2842572","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:32:08Z","timestamp":1783503128000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/jdr\/2842572"}},"subtitle":[],"editor":[{"given":"Hannah","family":"Wesley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/jdr\/2842572"],"URL":"https:\/\/doi.org\/10.1155\/jdr\/2842572","archive":["Portico"],"relation":{},"ISSN":["2314-6745","2314-6753"],"issn-type":[{"value":"2314-6745","type":"print"},{"value":"2314-6753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"2842572"}}