Persons with diabetes and general/family practitioner perspectives related to therapeutic inertia in type 2 diabetes mellitus using qualitative focus groups and the Theoretical Domains Framework: Results from the MOTION study

Abstract Therapeutic inertia in type 2 diabetes (T2DM) is the failure to receive timely treatment intensification as indicated per T2DM treatment guidelines. Multifactorial causes of therapeutic inertia in T2DM have been documented at the level of persons with diabetes (PwD), healthcare providers, and healthcare systems. We developed a 3-part mixed-methods research program called the “Moving to Overcome Therapeutic Inertia Obstacles Now in T2DM” (MOTION) Study to inform the development of strategies to address therapeutic inertia in T2DM. We present the results from focus groups which had the objectives of 1) understanding PwD and general practitioner/family practitioner (GPFP) determinants of behaviour related to treatment intensification using the Theoretical Domains Framework (TDF) and 2) identifying the sources of behaviours contributing to therapeutic inertia in T2DM as proposed by the Behaviour Change Wheel (BCW). Two focus groups with PwD and 4 with GPFPs were conducted. Transcripts from the focus groups were coded independently by two investigators to identify themes, mapped to TDF domains, and linked using the BCW. For PwD, the most commonly coded TDF domains were intentions, goals, knowledge, beliefs about consequences, and social influences. For GPFPs the most common domains were intentions, environmental context and resources, and social/professional role and identity. The BCW identified that PwD interventions should include reflective motivation, psychological capability, and social opportunity; GPFP interventions should include physical opportunity, social opportunity, and reflective motivation. Comprehensive strategies that target both PwD and GPFP barriers would encourage a more collaborative approach towards treatment intensification decisions and to reduce therapeutic inertia.