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Table 3 The six context-mechanism-outcome configurations and supporting citations

From: What works for whom in the management of diabetes in people living with dementia: a realist review

Title Context Mechanism and outcome Included evidence
1. Embedding positive attitudes towards PLWD If health and social care delivery systems propagate and reinforce positive attitudes towards people living with dementia and diabetes (PLWDD) and their families, through tailored self-management support Then this fosters a belief in staff that PLWDD have the potential to be involved in self-management (SM) and the right to access diabetes-related services (even when the trajectory is one of deterioration) (M) prompting treatment confidence in PLWDD (M), which leads to engagement in SM practices by PLWDD and their carers (O) [11, 12, 28, 37, 39,40,41, 53,54,55, 62, 6770, 73, 74, 80, 81, 88, 99, 100, 102, 104, 110]
2. Person-centred approaches to care planning If delivery systems promote a person-centred and partnership approach to care, allowing healthcare professionals (HCPs) to understand the individual needs and abilities of PLWDD and their family Then (1) HCPs feel confident that they are acting in the best interests of PLWDD and family (M), and this (2) generates trust between HCP and PLWDD/family (M), leading to better fit between care planning and patient and carer needs and (potentially) a lessening of the burden of medicalisation experienced by PLWDD and their families (O) [26, 27, 31, 35, 37, 42, 43, 52,53,54, 58, 60, 62, 64, 65, 72, 75, 79, 82, 84, 89, 90, 93,94,95, 98, 100, 102, 105, 106]
3. Developing skills to provide tailored and flexible care If HCPs are expected to develop skills that enhance the delivery of individualised and tailored care to PLWDD (e.g. enablement rather than management, listening/communication/negotiation) Then this legitimates the work creating the expectation in patients and HCPs that the management of diabetes for PLWD is important (M), leading to the provision of more tailored diabetes care (O) and better engagement in self-management by PLWDD and family carers (O) [8, 26, 35, 44, 45, 58, 62, 64, 75, 78, 79, 82, 83, 85, 89, 91, 97, 102]
4. Regular contact If HCPs maintain regular contact over time (e.g. face-to-face, telephone, e-mail) with the PLWDD/family, monitoring and anticipating needs throughout the dementia trajectory Then HCPs feel more equipped to meet patient needs (M), and PLWDD/family believe themselves to be supported (M) through transition from functional independence to functional dependence (M), leading to improved diabetes management (O) [12, 26, 34, 36,37,38, 41, 43, 46, 57, 82,83,84,85,86, 92, 96, 98]
5. Family engagement If family carers are routinely involved in care planning and information sharing and are given the support they need to take on the tasks associated with managing diabetes in PLWD (e.g. medication management, recognition of hypoglycaemia) Then family carers will feel supported and believe their contribution is recognised and appreciated (M), leading to the development of effective self-management strategies on the part of the family carers (O) [11, 25, 26, 31, 33, 46, 47, 53, 64, 71, 72, 81, 92, 98, 110]
6. Usability of assistive devices As the dementia trajectory progresses, assistive technology needs to be tailored and adapted to the needs and requirements of PLWDD and family (includes social, environmental and cultural needs) with the focus on maintaining autonomy for the PLWDD This leads to PLWDD and family gaining awareness of the usefulness of assistive technology in their management of diabetes and dementia (M), leading to more effective and sustained use of assistive technology to maintain autonomy and diabetes self-management strategies (O) [11, 25, 34, 37, 48, 49, 51, 56, 59, 63, 69, 76, 77, 87, 95, 101, 103]
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