{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T19:30:08Z","timestamp":1774380608795,"version":"3.50.1"},"reference-count":80,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T00:00:00Z","timestamp":1595203200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T00:00:00Z","timestamp":1595203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["722619"],"award-info":[{"award-number":["722619"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["722619"],"award-info":[{"award-number":["722619"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["722619"],"award-info":[{"award-number":["722619"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008382","name":"Fundo Regional para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["UID\/NEU\/04539\/2019"],"award-info":[{"award-number":["UID\/NEU\/04539\/2019"]}],"id":[{"id":"10.13039\/100008382","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008382","name":"Fundo Regional para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["UID\/NEU\/04539\/2019"],"award-info":[{"award-number":["UID\/NEU\/04539\/2019"]}],"id":[{"id":"10.13039\/100008382","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>It is estimated that around 70% of Type 2 Diabetes Mellitus patients (T2DM) have Non-Alcoholic Fatty Liver Disease (NAFLD). Awareness and education are amongst the major shortcomings of the public health response to the increasing threat of NAFLD. Characterizing the specific NAFLD-related information needs of particular high-risk metabolic communities, for instance, T2DM patients, might aid in the development of evidence-based health promotion strategies, ultimately promoting NAFLD-awareness, treatment adherence and therapeutic success rates.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Semi-structured interviews with T2DM patients were conducted to gain insight into their awareness of NAFLD, including its relationship with insulin resistance and T2DM.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Awareness of NAFLD as a disease entity, as well as its progression to end-stage liver disease or its relationship with other metabolic conditions, including insulin resistance and T2DM was low. Surveillance behaviours were also suboptimal and perceptions on the self-management knowledge and praxis regarding lifestyle intervention components of T2DM treatment seemed detached from those of NAFLD.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings could inform the integration of NAFLD-related content in T2DM health promotion strategies. Rising awareness on NAFLD progression and its relationship with T2DM using culturally and community-relevant constructs might facilitate the development of primary and secondary prevention programmes to promote the adherence to lifestyle interventions by influencing NAFLD threat perceptions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12889-020-09249-5","type":"journal-article","created":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T12:04:22Z","timestamp":1595246662000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Insights from qualitative research on NAFLD awareness with a cohort of T2DM patients: time to go public with insulin resistance?"],"prefix":"10.1186","volume":"20","author":[{"given":"Mireia","family":"Alemany-Pag\u00e8s","sequence":"first","affiliation":[]},{"given":"Mariana","family":"Moura-Ramos","sequence":"additional","affiliation":[]},{"given":"Sara","family":"Ara\u00fajo","sequence":"additional","affiliation":[]},{"given":"Maria Paula","family":"Macedo","sequence":"additional","affiliation":[]},{"given":"Rog\u00e9rio T.","family":"Ribeiro","sequence":"additional","affiliation":[]},{"given":"Dulce","family":"do \u00d3","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Ramalho-Santos","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3295-1284","authenticated-orcid":false,"given":"Anabela Marisa","family":"Azul","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,7,20]]},"reference":[{"issue":"3","key":"9249_CR1","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.jhep.2018.10.033","volume":"70","author":"ZM Younossi","year":"2019","unstructured":"Younossi ZM. Non-alcoholic fatty liver disease \u2013 a global public health perspective. J Hepatol. 2019;70(3):531\u201344. https:\/\/doi.org\/10.1016\/j.jhep.2018.10.033.","journal-title":"J Hepatol"},{"issue":"1","key":"9249_CR2","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","volume":"70","author":"SK Asrani","year":"2019","unstructured":"Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151\u201371. https:\/\/doi.org\/10.1016\/j.jhep.2018.09.014.","journal-title":"J Hepatol"},{"issue":"1","key":"9249_CR3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/hep.29466","volume":"67","author":"C Estes","year":"2018","unstructured":"Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123\u201333.","journal-title":"Hepatology."},{"issue":"7","key":"9249_CR4","first-page":"434","volume":"55","author":"J Ludwig","year":"1980","unstructured":"Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55(7):434\u20138.","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"9249_CR5","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","volume":"62","author":"CD Byrne","year":"2015","unstructured":"Byrne CD, Targher G. Review NAFLD : a multisystem disease. J Hepatol. 2015;62(1):S47\u201364. https:\/\/doi.org\/10.1016\/j.jhep.2014.12.012.","journal-title":"J Hepatol"},{"issue":"4","key":"9249_CR6","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/S0016-5085(98)70599-2","volume":"114","author":"CP Day","year":"1998","unstructured":"Day CP, James OFW. Steatohepatitis: a tale of two \u201chits\u201d? Gastroenterology. 1998;114(4):842\u20135. https:\/\/doi.org\/10.1016\/S0016-5085(98)70599-2.","journal-title":"Gastroenterology"},{"key":"9249_CR7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1146\/annurev-pathol-012615-044224","volume":"11","author":"T Hardy","year":"2016","unstructured":"Hardy T, Oakley F, Anstee QM, Day CP. Nonalcoholic fatty liver disease : pathogenesis and disease spectrum. Annu Rev Pathol. 2016;11:451\u201396.","journal-title":"Annu Rev Pathol"},{"issue":"7","key":"9249_CR8","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","volume":"24","author":"SL Friedman","year":"2018","unstructured":"Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24(7):908\u201322.","journal-title":"Nat Med"},{"key":"9249_CR9","first-page":"1","volume":"1","author":"EM Brunt","year":"2015","unstructured":"Brunt EM, Wong VW, Nobili V, Day CP, Sookoian S, Maher JJ, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Prim. 2015;1:1\u201322.","journal-title":"Nat Rev Dis Prim"},{"issue":"11","key":"9249_CR10","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S2213-8587(14)70032-4","volume":"2","author":"H Yki-Jarvinen","year":"2014","unstructured":"Yki-Jarvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. Lancet Diabetes Endocrinol. 2014;2(11):901\u201310.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"9249_CR11","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","volume":"64","author":"ZM Younossi","year":"2016","unstructured":"Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease\u2014meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73\u201384.","journal-title":"Hepatology."},{"issue":"6","key":"9249_CR12","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1053\/j.gastro.2018.08.024","volume":"155","author":"F Kanwal","year":"2018","unstructured":"Kanwal F, Kramer JR, Mapakshi S, Natarajan Y, Chayanupatkul M, Richardson PA, et al. Risk of hepatocellular cancer in patients with non-alcoholic fatty liver disease. Gastroenterology. 2018;155(6):1828\u20131837.e2.","journal-title":"Gastroenterology"},{"issue":"7","key":"9249_CR13","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1038\/s41575-019-0145-7","volume":"16","author":"QM Anstee","year":"2019","unstructured":"Anstee QM, Reeves HL, Kotsiliti E, Govaere O, Heikenwalder M. From NASH to HCC: current concepts and future challenges. Nat Rev Gastroenterol Hepatol. 2019;16(7):411\u201328.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"9249_CR14","doi-asserted-by":"publisher","unstructured":"Pimpin L, Cortez-pinto H, Negro F, Corbould E, Lazarus V, Webber L, et al. Burden of liver disease in Europe : epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018. https:\/\/doi.org\/10.1016\/j.jhep.2018.05.011.","DOI":"10.1016\/j.jhep.2018.05.011"},{"key":"9249_CR15","first-page":"1","volume":"39","author":"J Cai","year":"2018","unstructured":"Cai J, Zhang X, Li H. Progress and challenges in the prevention and control of nonalcoholic fatty liver disease. Med Res Rev. 2018;39:1\u201321.","journal-title":"Med Res Rev"},{"issue":"2","key":"9249_CR16","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1002\/hep.22009","volume":"47","author":"S Bellentani","year":"2008","unstructured":"Bellentani S, Grave RD, Suppini A. Behavior therapy for nonalcoholic fatty liver disease: the need for a multidisciplinary approach. Hepatology. 2008;47(2):746\u201354.","journal-title":"Hepatology"},{"issue":"4","key":"9249_CR17","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jhep.2013.05.044","volume":"59","author":"F Nascimbeni","year":"2013","unstructured":"Nascimbeni F, Pais R, Bellentani S, Day CP, Ratziu V, Loria P, et al. From NAFLD in clinical practice to answers from guidelines. J Hepatol. 2013;59(4):859\u201371.","journal-title":"J Hepatol"},{"issue":"10","key":"9249_CR18","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1007\/s10620-013-2740-8","volume":"58","author":"AC Wieland","year":"2013","unstructured":"Wieland AC, Quallick M. Identifying practice gaps to optimize medical care for patients with nonalcoholic fatty liver disease. Dig Dis Sci. 2013;58(10):2809\u201316.","journal-title":"Dig Dis Sci"},{"issue":"2","key":"9249_CR19","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/imj.13667","volume":"48","author":"PJ Patel","year":"2018","unstructured":"Patel PJ, Banh X, Horsfall LU, Hayward KL, Hossain F, Johnson T, et al. Underappreciation of non-alcoholic fatty liver disease by primary care clinicians: limited awareness of surrogate markers of fibrosis. Intern Med J. 2018;48(2):144\u201351.","journal-title":"Intern Med J"},{"key":"9249_CR20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-015-1837-x","volume":"9","author":"SP Briceno","year":"2016","unstructured":"Briceno SP, Glass D, Stuntz M, Caze A. Awareness of nonalcoholic steatohepatitis and associated practice patterns of primary care physicians and specialists. BMC Res Notes. 2016;9:1\u201312.","journal-title":"BMC Res Notes"},{"issue":"11","key":"9249_CR21","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1111\/j.1440-1746.2009.05914.x","volume":"24","author":"CM Leung","year":"2009","unstructured":"Leung CM, Lai LSW, Wong WH, Chan KH, Luk YW, Lai JY, et al. Non-alcoholic fatty liver disease: an expanding problem with low levels of awareness in Hong Kong. J Gastroenterol Hepatol. 2009;24(11):1786\u201390.","journal-title":"J Gastroenterol Hepatol"},{"issue":"March","key":"9249_CR22","first-page":"1","volume":"1","author":"V Ghevariya","year":"2014","unstructured":"Ghevariya V, Sandar N, Patel K, Ghevariya N, Shah R, Aron J. Knowing what \u2019 s out there : awareness of non-alcoholic fatty liver disease. Front Med. 2014;1(March):1\u20135.","journal-title":"Front Med"},{"issue":"1","key":"9249_CR23","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1097\/MCG.0000000000000075","volume":"49","author":"AC Wieland","year":"2015","unstructured":"Wieland AC, Mettler P, Mcdermott MT, Crane LA, Cicutto LC, Bambha KM. Low Awareness of Nonalcoholic Fatty Liver Disease Among Patients at High Metabolic Risk. J Clin Gastroenterol. 2015;49(1):e6\u2013e10.","journal-title":"J Clin Gastroenterol"},{"issue":"17","key":"9249_CR24","doi-asserted-by":"crossref","first-page":"4362","DOI":"10.3748\/wjg.v22.i17.4362","volume":"22","author":"L Mlynarsky","year":"2016","unstructured":"Mlynarsky L, Schlesinger D, Lotan R, Webb M, Halpern Z, Santo E, et al. Non-alcoholic fatty liver disease is not associated with a lower health perception. World J Gastroenterol. 2016;22(17):4362\u201372.","journal-title":"World J Gastroenterol"},{"issue":"11","key":"9249_CR25","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1016\/j.jacc.2010.09.073","volume":"57","author":"C-M Kastorini","year":"2011","unstructured":"Kastorini C-M, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299\u2013313 http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0735109710050679.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"9249_CR26","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.cld.2013.09.009","volume":"18","author":"F Barrera","year":"2014","unstructured":"Barrera F, George J. The role of diet and nutritional intervention for the management of patients with NAFLD. Clin Liver Dis. 2014;18(1):91\u2013112. https:\/\/doi.org\/10.1016\/j.cld.2013.09.009.","journal-title":"Clin Liver Dis"},{"key":"9249_CR27","first-page":"6","volume":"33","author":"MD Kontogianni","year":"2013","unstructured":"Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr. 2013;33:6\u201311.","journal-title":"Clin Nutr"},{"issue":"6","key":"9249_CR28","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","volume":"64","author":"G Marchesini","year":"2016","unstructured":"Marchesini G, Day CP, Dufour JF, Canbay A, Nobili V, Ratziu V, et al. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388\u2013402. https:\/\/doi.org\/10.1016\/j.jhep.2015.11.004.","journal-title":"J Hepatol"},{"issue":"4","key":"9249_CR29","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jhep.2017.05.016","volume":"67","author":"M Romero-G\u00f3mez","year":"2017","unstructured":"Romero-G\u00f3mez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829\u201346.","journal-title":"J Hepatol"},{"key":"9249_CR30","doi-asserted-by":"publisher","unstructured":"Lazarus JV, Ekstedt M, Tacke F, Cortez H, Anstee QM, Peric\u00e0s JM, et al. A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe non-alcoholic fatty liver disease in Europe. J Hepatol. 2019. https:\/\/doi.org\/10.1016\/j.jhep.2019.08.027.","DOI":"10.1016\/j.jhep.2019.08.027"},{"issue":"2","key":"9249_CR31","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","volume":"149","author":"E Vilar-Gomez","year":"2015","unstructured":"Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367\u2013378.e5. https:\/\/doi.org\/10.1053\/j.gastro.2015.04.005.","journal-title":"Gastroenterology"},{"issue":"3","key":"9249_CR32","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.jhep.2013.04.013","volume":"59","author":"VW Wong","year":"2013","unstructured":"Wong VW, Chan RS, Wong GL, Cheung BH, Chu WC, Yeung DK, et al. Community-based lifestyle modification programme for non-alcoholic fatty liver disease : a randomized controlled trial. J Hepatol. 2013;59(3):536\u201342. https:\/\/doi.org\/10.1016\/j.jhep.2013.04.013.","journal-title":"J Hepatol"},{"key":"9249_CR33","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/2008-7802.200854","volume":"8","author":"A Arab","year":"2017","unstructured":"Arab A, Askari G, Golshiri P, Feizi A, Hekmatnia A, Iraj B, et al. The effect of a lifestyle modification education on adiposity measures in overweight and obese nonalcoholic fatty liver disease patients. Int J Prev Med. 2017;8:10.","journal-title":"Int J Prev Med"},{"issue":"4","key":"9249_CR34","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.jhep.2012.11.031","volume":"58","author":"E Centis","year":"2013","unstructured":"Centis E, Moscatiello S, Bugianesi E, Bellentani S, Fracanzani AL, Calugi S, et al. Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease. J Hepatol. 2013;58(4):771\u20137. https:\/\/doi.org\/10.1016\/j.jhep.2012.11.031.","journal-title":"J Hepatol"},{"key":"9249_CR35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/109019818401100101","volume":"11","author":"K Janz","year":"1984","unstructured":"Janz K, Becker MH. The health belief model : a decade later. Health Educ Q. 1984;11:1\u201347.","journal-title":"Health Educ Q"},{"key":"9249_CR36","doi-asserted-by":"crossref","unstructured":"Fisher WA, Fisher JD, Harman J. The information-motivation-behavioraI skills model: a general social psychological approach to understanding and promoting health behavior. In: Social psychological foundations of health and illness. Fisher, William A.: U Western Ontario, Dept of Psychology, London, ON, Canada, N6A 5C2, fisher@uwo.ca: Blackwell Publishing; 2003. p. 82\u2013106. (Blackwell series in health psychology and behavioral medicine.).","DOI":"10.1002\/9780470753552.ch4"},{"key":"9249_CR37","volume-title":"Health behavior and health education : theory, research, and practice","author":"K Glanz","year":"2008","unstructured":"Glanz K, Rimer BK, Viswanath K. Health behavior and health education : theory, research, and practice. San Francisco: Jossey-Bass; 2008."},{"key":"9249_CR38","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","volume":"84","author":"A Bandura","year":"1977","unstructured":"Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191\u2013215 US: American Psychological Association.","journal-title":"Psychol Rev"},{"key":"9249_CR39","unstructured":"The NASH Education Program [Internet]. 2018 [cited 2018 Jun 27]. Available from: https:\/\/www.the-nash-education-program.com\/."},{"key":"9249_CR40","unstructured":"British Liver Trust [Internet]. [cited 2017 Aug 15]. Available from: https:\/\/www.britishlivertrust.org.uk\/."},{"issue":"1","key":"9249_CR41","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.clnu.2014.01.018","volume":"34","author":"FM Trovato","year":"2015","unstructured":"Trovato FM, Catalano D, Martines GF, Pace P, Trovato GM. Mediterranean diet and non-alcoholic fatty liver disease the need of extended and comprehensive interventions. Clin Nutr. 2015;34(1):86\u20138. https:\/\/doi.org\/10.1016\/j.clnu.2014.01.018.","journal-title":"Clin Nutr"},{"key":"9249_CR42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11894-015-0472-y","volume":"18","author":"K Hallsworth","year":"2016","unstructured":"Hallsworth K, Avery L, Trenell MI. Targeting lifestyle behavior change in adults with NAFLD during a 20-min consultation : summary of the dietary and exercise literature. Curr Gastroentrol Rep. 2016;18:1\u20137.","journal-title":"Curr Gastroentrol Rep"},{"issue":"12","key":"9249_CR43","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1016\/j.socscimed.2008.09.050","volume":"67","author":"D Nutbeam","year":"2008","unstructured":"Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072\u20138. https:\/\/doi.org\/10.1016\/j.socscimed.2008.09.050.","journal-title":"Soc Sci Med"},{"issue":"3","key":"9249_CR44","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","volume":"15","author":"D Nutbeam","year":"2000","unstructured":"Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259\u201367. https:\/\/doi.org\/10.1093\/heapro\/15.3.259.","journal-title":"Health Promot Int"},{"issue":"2","key":"9249_CR45","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.jhep.2016.04.005","volume":"65","author":"SM Francque","year":"2016","unstructured":"Francque SM, van der Graaff D, Kwanten WJ. Non-alcoholic fatty liver disease and cardiovascular risk: pathophysiological mechanisms and implications. J Hepatol. 2016;65(2):425\u201343.","journal-title":"J Hepatol"},{"issue":"1","key":"9249_CR46","first-page":"11","volume":"8","author":"ZQ Al-Busaidi","year":"2008","unstructured":"Al-Busaidi ZQ. Qualitative research and its uses in health care. Sultan Qaboos Univ Med J. 2008;8(1):11\u20139.","journal-title":"Sultan Qaboos Univ Med J"},{"issue":"4","key":"9249_CR47","first-page":"255","volume":"16","author":"VA Lambert","year":"2012","unstructured":"Lambert VA, Lambert CE. Editorial : qualitative descriptive research : an acceptable design. Pac Rim Int J Nurs Res. 2012;16(4):255\u20136.","journal-title":"Pac Rim Int J Nurs Res"},{"key":"9249_CR48","unstructured":"Associa\u00e7\u00e3o Protectora dos Diab\u00e9ticos de Portugal A. Portuguese Diabetes Association [Internet]. Available from: apdp.pt."},{"issue":"2","key":"9249_CR49","doi-asserted-by":"crossref","first-page":"103","DOI":"10.3109\/13814788.2014.1000855","volume":"21","author":"L Laranjo","year":"2015","unstructured":"Laranjo L, Neves AL, Costa A, Ribeiro RT, Couto L, Sa AB. Facilitators, barriers and expectations in the self-management of type 2 diabetes--a qualitative study from Portugal. Eur J Gen Pract. 2015;21(2):103\u201310.","journal-title":"Eur J Gen Pract"},{"key":"9249_CR50","doi-asserted-by":"crossref","unstructured":"Ribeiro RT, Boavida JM. Comparison of healthcare costs between an implemented integrated diabetes care unit and the traditional national health system comparison of healthcare costs between an implemented integrated diabetes care unit and the traditional national health system. 2016;(December).","DOI":"10.5334\/ijic.2798"},{"issue":"5","key":"9249_CR51","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","volume":"42","author":"LA Palinkas","year":"2015","unstructured":"Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Admin Pol Ment Health. 2015;42(5):533\u201344.","journal-title":"Admin Pol Ment Health"},{"issue":"2","key":"9249_CR52","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/nur.4770180211","volume":"18","author":"M Sandelowski","year":"1995","unstructured":"Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179\u201383.","journal-title":"Res Nurs Health"},{"key":"9249_CR53","unstructured":"Krippendorff KH. Content analysis: an introduction to its methodology."},{"key":"9249_CR54","first-page":"2017","volume-title":"MAXQDA 2018 [computer software]","author":"VERBI Software","year":"2017","unstructured":"VERBI Software. MAXQDA 2018 [computer software]. Berlin: VERBI Software; 2017. p. 2017."},{"issue":"1","key":"9249_CR55","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1080\/13814788.2017.1375092","volume":"24","author":"I Korstjens","year":"2018","unstructured":"Korstjens I, Moser A. Series: practical guidance to qualitative research. Part 4: trustworthiness and publishing. Eur J Gen Pract. 2018;24(1):120\u20134. https:\/\/doi.org\/10.1080\/13814788.2017.1375092.","journal-title":"Eur J Gen Pract"},{"issue":"1\u20132","key":"9249_CR56","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0020-7489(98)00014-5","volume":"35","author":"J Sim","year":"1998","unstructured":"Sim J, Sharp K. A critical appraisal of the role of triangulation in nursing research. Int J Nurs Stud. 1998;35(1\u20132):23\u201331.","journal-title":"Int J Nurs Stud"},{"key":"9249_CR57","volume-title":"Naturalistic inquiry","author":"SY Lincoln","year":"1985","unstructured":"Lincoln SY, Guba EG. Naturalistic inquiry. Beverly Hills: Sage Publications, Inc.; 1985."},{"key":"9249_CR58","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","volume":"22","author":"ML Mchugh","year":"2012","unstructured":"Mchugh ML. Lessons in biostatistics Interrater reliability : the kappa statistic. Boichem Med. 2012;22:276\u201382.","journal-title":"Boichem Med"},{"key":"9249_CR59","unstructured":"Global report on diabetes. World heal organ. 2016;."},{"issue":"10","key":"9249_CR60","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.3748\/wjg.v23.i10.1881","volume":"23","author":"S Zelber-sagi","year":"2017","unstructured":"Zelber-sagi S, Bord S, Dror-lavi G, Smith ML, Towne SD Jr, Buch A, et al. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J Gastroenterol. 2017;23(10):1881\u201390.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"9249_CR61","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jhep.2009.10.010","volume":"52","author":"J Frith","year":"2010","unstructured":"Frith J, Day CP, Robinson L, Elliott C, Jones DEJ, Newton JL. Potential strategies to improve uptake of exercise interventions in non-alcoholic fatty liver disease. J Hepatol. 2010;52(1):112\u20136. https:\/\/doi.org\/10.1016\/j.jhep.2009.10.010.","journal-title":"J Hepatol"},{"issue":"March","key":"9249_CR62","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2337\/dc16-1787","volume":"40","author":"F Bril","year":"2017","unstructured":"Bril F, Cusi K. Management of nonalcoholic fatty liver disease in patients with type 2 diabetes : a call to action. Diabetes Care. 2017;40(March):419\u201330.","journal-title":"Diabetes Care"},{"key":"9249_CR63","doi-asserted-by":"publisher","unstructured":"Younossi ZM. Practice management : the road ahead patient-reported outcomes for patients with chronic liver disease. Clin Gastroenterol Hepatol. 2018. https:\/\/doi.org\/10.1016\/j.cgh.2017.12.028.","DOI":"10.1016\/j.cgh.2017.12.028"},{"key":"9249_CR64","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s41687-018-0052-7","volume":"2","author":"T Kennedy-Martin","year":"2018","unstructured":"Kennedy-Martin T, Bae JP, Paczkowski R, Freeman E. Health-related quality of life burden of nonalcoholic steatohepatitis : a robust pragmatic literature review. J Patient Rep Outcomes. 2018;2:1\u201314.","journal-title":"J Patient Rep Outcomes"},{"issue":"7258","key":"9249_CR65","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/bmj.321.7258.405","volume":"321","author":"IM Stratton","year":"2000","unstructured":"Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405\u201312.","journal-title":"BMJ."},{"key":"9249_CR66","volume-title":"The precaution adoption process model the precaution adoption process model","author":"ND Weinstein","year":"2008","unstructured":"Weinstein ND, Blalock SJ, Sandman PM, Weinstein ND. The precaution adoption process model the precaution adoption process model; 2008."},{"key":"9249_CR67","first-page":"2003","volume-title":"Adherence to long-term therapies","author":"World Health Organization","year":"2003","unstructured":"World Health Organization. Adherence to long-term therapies. Geneva: World Health Organization; 2003. p. 2003."},{"issue":"8","key":"9249_CR68","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/MCG.0b013e31820989d3","volume":"45","author":"AG Singal","year":"2011","unstructured":"Singal AG, Volk ML, Rakoski MO, Fu S, Su GL, Mccurdy H, et al. Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma. J Clin Gastroenterol. 2011;45(8):727\u201332.","journal-title":"J Clin Gastroenterol"},{"issue":"4","key":"9249_CR69","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/BF00054773","volume":"5","author":"A Young","year":"1981","unstructured":"Young A. When rational men fall sick: an inquiry into some assumptions made by medical anthropologists. Cult Med Psychiatry. 1981;5(4):317\u201335.","journal-title":"Cult Med Psychiatry"},{"key":"9249_CR70","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781139166515","volume-title":"Human motives and cultural models [internet]. Publications of the Society for Psychological Anthropology","author":"RG D\u2019Andrade","year":"1992","unstructured":"D\u2019Andrade RG, Strauss C. Human motives and cultural models [internet]. Publications of the Society for Psychological Anthropology. Cambridge: Cambridge University Press; 1992. Available from: https:\/\/www.cambridge.org\/core\/books\/human-motives-and-cultural-models\/A75A5E175145304BB07B798698D6495B."},{"issue":"5","key":"9249_CR71","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1590\/S0034-71672011000500002","volume":"64","author":"D Groleau","year":"2011","unstructured":"Groleau D. Embodying \u2018 health citizenship \u2019 in health knowledge to fi ght health inequalities. Rev Bras Enferm. 2011;64(5):811\u20136.","journal-title":"Rev Bras Enferm"},{"key":"9249_CR72","doi-asserted-by":"crossref","DOI":"10.1525\/9780520340848","volume-title":"Patients and healers in the context of culture : an exploration of the borderland between anthropology, medicine, and psychiatry","author":"A Kleinman","year":"1980","unstructured":"Kleinman A. Patients and healers in the context of culture : an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press; 1980."},{"issue":"3","key":"9249_CR73","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1007\/s00535-017-1415-1","volume":"53","author":"Y Sumida","year":"2018","unstructured":"Sumida Y, Yoneda M. Current and future pharmacological therapies for NAFLD \/ NASH. J Gastroenterol. 2018;53(3):362\u201376. https:\/\/doi.org\/10.1007\/s00535-017-1415-1.","journal-title":"J Gastroenterol"},{"issue":"6","key":"9249_CR74","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/0020-7489(95)00043-5","volume":"32","author":"VE Coates","year":"1995","unstructured":"Coates VE, Boore JRP. Self-management of chronic illness: implications for nursing. Int J Nurs Stud. 1995;32(6):628\u201340 Available from: http:\/\/www.sciencedirect.com\/science\/article\/pii\/0020748995000435.","journal-title":"Int J Nurs Stud"},{"issue":"4","key":"9249_CR75","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1111\/j.1467-9566.1991.tb00522.x","volume":"13","author":"M Bury","year":"1991","unstructured":"Bury M. The sociology of chronic illness : a review of research and prospects. Sociol Health Illn. 1991;13(4):451\u201368.","journal-title":"Sociol Health Illn"},{"issue":"1","key":"9249_CR76","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1177\/104973239300300103","volume":"3","author":"MJ Price","year":"1993","unstructured":"Price MJ. An experiential model of learning diabetes self-management. Qual Health Res. 1993;3(1):29\u201354. https:\/\/doi.org\/10.1177\/104973239300300103.","journal-title":"Qual Health Res"},{"key":"9249_CR77","volume-title":"Association of health literacy and diabetes self-management : a systematic review","author":"PK Dahal","year":"2018","unstructured":"Dahal PK, Hosseinzadeh H. Association of health literacy and diabetes self-management : a systematic review; 2018."},{"issue":"1","key":"9249_CR78","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00592-017-1071-1","volume":"55","author":"R Caruso","year":"2017","unstructured":"Caruso R, Magon A, Baroni I, Dellafiore F. Health literacy in type 2 diabetes patients : a systematic review of systematic reviews. Acta Diabetol. 2017;55(1):1\u201312.","journal-title":"Acta Diabetol"},{"issue":"4","key":"9249_CR79","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1001\/jama.288.4.475","volume":"288","author":"D Schillinger","year":"2002","unstructured":"Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475\u201382.","journal-title":"JAMA."},{"issue":"1","key":"9249_CR80","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1177\/0145721706297452","volume":"33","author":"CK Powell","year":"2007","unstructured":"Powell CK, Hill EG, Clancy DE. The relationship between health literacy and diabetes knowledge and readiness to take health actions. Diabetes Educ. 2007;33(1):144\u201351.","journal-title":"Diabetes Educ"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-09249-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-020-09249-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-09249-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T23:29:53Z","timestamp":1626737393000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-020-09249-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,20]]},"references-count":80,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["9249"],"URL":"https:\/\/doi.org\/10.1186\/s12889-020-09249-5","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,20]]},"assertion":[{"value":"5 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Ethics Committee for Health of the Portuguese Diabetes Association (APDP, N\u00b0231\/2018). Written informed consent was obtained from all participants in the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors have potential conflicts of interest to be disclosed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1142"}}